Provider Demographics
NPI:1497950240
Name:RICE, WESLEI A (MD)
Entity Type:Individual
Prefix:
First Name:WESLEI
Middle Name:A
Last Name:RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-1903
Mailing Address - Country:US
Mailing Address - Phone:979-774-2079
Mailing Address - Fax:
Practice Address - Street 1:2210 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1903
Practice Address - Country:US
Practice Address - Phone:979-774-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118401207Q00000X
TXM9609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9609OtherTEXAS MEDICAL LICENSE
IL036-118401OtherSTATE LICENSE