Healthcare Provider Details

I. General information

NPI: 1154446631
Provider Name (Legal Business Name): JOSEPH C RICE P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ORTHOPAEDIC PL
ST AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

345 N SHORE CIR #1226
ST AUGUSTINE FL
32092-2779
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0540
  • Fax: 904-217-8057
Mailing address:
  • Phone: 617-710-1053
  • Fax: 904-217-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1061
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9105420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: