Provider Demographics
NPI:1609870112
Name:REX, IRA H III (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:H
Last Name:REX
Suffix:III
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 1:10 N MAIN ST
Mailing Address - Street 2:FL 3
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2130
Mailing Address - Country:US
Mailing Address - Phone:508-674-6100
Mailing Address - Fax:508-674-6197
Practice Address - Street 1:10 N MAIN ST
Practice Address - Street 2:FL 3
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2130
Practice Address - Country:US
Practice Address - Phone:508-674-6100
Practice Address - Fax:508-674-6197
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2221266OtherAETNA US HEALTHCARE
MA491294OtherUS HEALTH
MA797314OtherTUFTS HEALTH PLAN
MA0019396OtherNEIGHBORHOOD HEALTH PLAN
MA21215OtherHARVARD PILGRIM HEALTH
MAM17366OtherBLUE CROSS BLUE SHIELD
RI204281OtherBLUECHIP
RI4833-8OtherBLUE CROSS BLUE SHIELD
MA2221266OtherAETNA US HEALTHCARE
MA491294OtherUS HEALTH
MA1609870112Medicare UPIN