Healthcare Provider Details

I. General information

NPI: 1194731679
Provider Name (Legal Business Name): MARY JO RICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

4656 SW FLOWER PL
PORTLAND OR
97221-2930
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-5750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD13759
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: