Provider Demographics
NPI:1598733412
Name:RICE, TAMARA (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:DEE
Other - Last Name:VAN DERAA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2817 SAINT JOHNS BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1563
Mailing Address - Country:US
Mailing Address - Phone:417-781-2727
Mailing Address - Fax:417-625-2279
Practice Address - Street 1:2817 SAINT JOHNS BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1563
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:417-625-2279
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008193207L00000X, 207LA0401X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100420090BMedicaid
OK100062670AMedicaid
MO205839707Medicaid
MO205839707Medicaid