Provider Demographics
NPI:1710917711
Name:REGINALD D RICE JR MD PROF. CORP.
Entity Type:Organization
Organization Name:REGINALD D RICE JR MD PROF. CORP.
Other - Org Name:RICE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN & SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:DIETEL
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:916-941-9400
Mailing Address - Street 1:2211 FRANCISCO DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3759
Mailing Address - Country:US
Mailing Address - Phone:916-941-9400
Mailing Address - Fax:
Practice Address - Street 1:2211 FRANCISCO DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3759
Practice Address - Country:US
Practice Address - Phone:916-941-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G703570174400000X
207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6986027Medicaid
CA6986027Medicaid