Provider Demographics
NPI:1760488753
Name:RICE, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 HAYES AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7252
Mailing Address - Country:US
Mailing Address - Phone:419-627-8771
Mailing Address - Fax:419-627-0363
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:BLDG D
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7252
Practice Address - Country:US
Practice Address - Phone:419-627-8771
Practice Address - Fax:419-627-0363
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046708208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2008071Medicaid
OH02564OtherPARAMOUNT
OH920613OtherAETNA
OH000000131160OtherANTHEM
OH02564OtherPARAMOUNT
OH0498004Medicare PIN
OH920613OtherAETNA
OH0498003Medicare PIN