Healthcare Provider Details

I. General information

NPI: 1891801049
Provider Name (Legal Business Name): DENNIS A ICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MEDICAL DRIVE
AMARILLO TX
79106-1781
US

IV. Provider business mailing address

11 MEDICAL DRIVE
AMARILLO TX
79106-1781
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-6400
  • Fax:
Mailing address:
  • Phone: 806-353-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberK0068
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: