Provider Demographics
NPI:1811144819
Name:RICE, LEONARD OTIS (MD)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:OTIS
Last Name:RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEONARD
Other - Middle Name:OTIS
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:630 BROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:RINEYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40162
Mailing Address - Country:US
Mailing Address - Phone:270-505-3647
Mailing Address - Fax:270-735-1752
Practice Address - Street 1:851 IRELAND AVE.
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:40162
Practice Address - Country:US
Practice Address - Phone:502-624-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine