Provider Demographics
NPI:1255348074
Name:RICE, JOHN VAL (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:VAL
Last Name:RICE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 N 13TH LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2169
Mailing Address - Country:US
Mailing Address - Phone:360-427-0366
Mailing Address - Fax:360-427-5879
Practice Address - Street 1:1812 N 13TH LOOP RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2169
Practice Address - Country:US
Practice Address - Phone:360-427-0366
Practice Address - Fax:360-427-5879
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP0412213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1160290Medicaid
WAT89001Medicare UPIN
WA1160290Medicaid