Provider Demographics
NPI:1659392421
Name:RICE, DANA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N JEFFERSON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2375
Mailing Address - Country:US
Mailing Address - Phone:903-572-9823
Mailing Address - Fax:903-572-4812
Practice Address - Street 1:2001 N JEFFERSON AVE STE 300
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2375
Practice Address - Country:US
Practice Address - Phone:903-572-9823
Practice Address - Fax:903-572-4812
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024390208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1571903Medicaid
LA4E849F600Medicare ID - Type Unspecified
LA1571903Medicaid