Healthcare Provider Details

I. General information

NPI: 1093719833
Provider Name (Legal Business Name): CLIFFORD H RICE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E BERT KOUNS LOOP
SHREVEPORT LA
71105-5634
US

IV. Provider business mailing address

1455 E BERT KOUNS LOOP
SHREVEPORT LA
71105-5634
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-4464
  • Fax: 318-798-4529
Mailing address:
  • Phone: 318-798-4464
  • Fax: 318-798-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number024389
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: