Provider Demographics
NPI:1891801049
Name:ICE, DENNIS A (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:ICE
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 1:11 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1781
Mailing Address - Country:US
Mailing Address - Phone:806-353-6400
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1781
Practice Address - Country:US
Practice Address - Phone:806-353-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0068208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115738101OtherSOUTHWEST LIFE & HEALTH
TX148784502Medicaid
TX8Z0461OtherBCBS
TX115738101OtherFIRST CARE
TXP00045527OtherMEDICARE RAILROAD
TX8739B0Medicare PIN
TX148784502Medicaid