Provider Demographics
NPI:1821067430
Name:RICE, DAVID WATSON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WATSON
Last Name:RICE
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 1:605 GLENWOOD DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1108
Mailing Address - Country:US
Mailing Address - Phone:423-697-9890
Mailing Address - Fax:423-697-9891
Practice Address - Street 1:605 GLENWOOD DR
Practice Address - Street 2:SUITE 212
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1108
Practice Address - Country:US
Practice Address - Phone:423-697-9890
Practice Address - Fax:423-697-9891
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000304862085R0001X
GA0455962085R0001X
AL000253252085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0140050151OtherCIGNA
GA00796672BMedicaid
3152134OtherBLUECROSS AND BLUESHIELD
TN3824527Medicaid
0140050151OtherCIGNA
TN3824527Medicaid