Provider Demographics
NPI:1619354453
Name:RICE, ORRIN D (PA-C)
Entity Type:Individual
Prefix:
First Name:ORRIN
Middle Name:D
Last Name:RICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PLAZA DR
Mailing Address - Street 2:STE A
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5110
Mailing Address - Country:US
Mailing Address - Phone:573-332-7746
Mailing Address - Fax:573-339-9709
Practice Address - Street 1:1723 BROADWAY
Practice Address - Street 2:SUITE 410
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-332-7746
Practice Address - Fax:573-339-9709
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015012669363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015012669OtherMO STATE LICENSE