Provider Demographics
NPI:1295782126
Name:RICE, LAURA Z (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:Z
Last Name:RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 DATAPOINT, SUITE 600
Mailing Address - Street 2:P. O. BOX 29441
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0441
Mailing Address - Country:US
Mailing Address - Phone:210-616-7796
Mailing Address - Fax:210-616-7799
Practice Address - Street 1:8401 DATAPOINT DR STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5907
Practice Address - Country:US
Practice Address - Phone:210-616-7796
Practice Address - Fax:210-616-7799
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ66932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01577350OtherRAILROAD MEDICARE
TXP01577827OtherRAILROAD MEDICARE
TX3520900-03Medicaid
TXQ6693OtherTEXAS MEDICAL LICENSE
TX3520900-01Medicaid
TX3520900-02Medicaid
TXQ6693OtherTEXAS MEDICAL LICENSE
TX3520900-02Medicaid