Healthcare Provider Details

I. General information

NPI: 1306176235
Provider Name (Legal Business Name): LEVI ANDREW RICE JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2009
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST STE 130
DURANGO CO
81301-7306
US

IV. Provider business mailing address

221 W. COLORADO BLVD. PAVILION II SUITE 831
DALLAS TX
75208
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-1120
  • Fax: 970-247-1128
Mailing address:
  • Phone: 214-933-7430
  • Fax: 214-947-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberN5359
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0061835
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberN5359
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: