Provider Demographics
NPI:1558356782
Name:RICE, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 BOY SCOUT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1179
Practice Address - Street 1:3080 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6720
Practice Address - Country:US
Practice Address - Phone:941-883-2199
Practice Address - Fax:941-979-5041
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00787262085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7455042OtherAETNA PROVIDER NUMBER
FL300513500Medicaid
FL60602OtherOP. ENG. LOC. 825 PROV. #
FLL4392OtherMEDICARE
FLME78726AOtherMETCARE PROVIDER NUMBER
FLL4391OtherMEDICARE
FLP303133OtherFREEDOM HEALTH
FL263156OtherAVMED PROVIDER NUMBER
FL36-05447OtherUTD. HLTHCR. PROV. #
FL5899OtherAVMED PIN NUMBER
FL592485899OtherMETCARE VENDOR ID #
FL5556120-001OtherCIGNA PROVIDER NUMBER
FL60602OtherOP. ENG. LOC. 825 PROV. #