Provider Demographics
NPI:1821079492
Name:RICE, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-838-5702
Mailing Address - Fax:314-839-5596
Practice Address - Street 1:637 DUNN RD STE 170
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1759
Practice Address - Country:US
Practice Address - Phone:314-838-5702
Practice Address - Fax:314-839-5596
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7B73207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO127485OtherGHP
MO19663OtherBCBS
MOA12312OtherMERCY
MO000000010030OtherESSENCE
19663OtherBCBS
MO0000000124621OtherESSENCE - ST CHARLES
MO102194OtherHEALTHLINK
MO0400418OtherUHC - FLORISSANT OFFICE
MO0404687OtherUHC ST CHARLES
MO4000892OtherAETNA
MO0404687OtherUHC ST CHARLES
MO0400418OtherUHC - FLORISSANT OFFICE
MO19663OtherBCBS
MO102194OtherHEALTHLINK