Provider Demographics
NPI:1508963695
Name:RICE-DORROUGH, MOLLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:
Last Name:RICE-DORROUGH
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 1:1411 N BECKLEY AVE STE 356
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1591
Mailing Address - Country:US
Mailing Address - Phone:469-290-6400
Mailing Address - Fax:469-290-6405
Practice Address - Street 1:1411 N BECKLEY AVE STE 356
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1591
Practice Address - Country:US
Practice Address - Phone:469-290-6400
Practice Address - Fax:469-290-6405
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82V271OtherBCBS
TX116881702Medicaid
TX82V271OtherBCBS
TX82V271Medicare PIN