Healthcare Provider Details

I. General information

NPI: 1598733412
Provider Name (Legal Business Name): TAMARA RICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA DEE VAN DERAA MD

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 SAINT JOHNS BLVD
JOPLIN MO
64804-1563
US

IV. Provider business mailing address

2817 SAINT JOHNS BLVD
JOPLIN MO
64804-1563
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-2727
  • Fax: 417-625-2279
Mailing address:
  • Phone: 417-781-2727
  • Fax: 417-625-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2002008193
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number2002008193
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number2002008193
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2002008193
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: