Provider Demographics
NPI:1558004754
Name:RICE, DONALD GEORGE JR
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:GEORGE
Last Name:RICE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 IRENE CT
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1720
Mailing Address - Country:US
Mailing Address - Phone:319-230-1911
Mailing Address - Fax:
Practice Address - Street 1:130 IRENE CT
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-1720
Practice Address - Country:US
Practice Address - Phone:319-230-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA613AH8855172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver