Healthcare Provider Details

I. General information

NPI: 1164439204
Provider Name (Legal Business Name): JOHN V RICE DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N 13TH LOOP RD
SHELTON WA
98584-2169
US

IV. Provider business mailing address

P.O. BOX 266
SHELTON WA
98584
US

V. Phone/Fax

Practice location:
  • Phone: 360-427-0366
  • Fax: 360-427-5879
Mailing address:
  • Phone: 360-427-0366
  • Fax: 360-427-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO412
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRETCHEN A. RICE
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-427-0366