Provider Demographics
NPI:1720035124
Name:BICE, MATTHEW M (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:M
Last Name:BICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 CONVENTION ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3803
Mailing Address - Country:US
Mailing Address - Phone:225-381-6249
Mailing Address - Fax:225-336-2912
Practice Address - Street 1:3870 CONVENTION ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3803
Practice Address - Country:US
Practice Address - Phone:225-381-6249
Practice Address - Fax:225-336-2912
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00469197OtherRAILROAD
LA1720035124OtherNPI
LA1682799Medicaid
LA1720035124OtherNPI
LAP00469197OtherRAILROAD