MEDICARE: MR. RALPH WILSON RICE JR. PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1023104460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH WILSON RICE JR. PAC

Provider Business Mailing Address
First Line	:	100176 UNIVERSITY OF FLORIDA
Second Line	:	SCHOOL OF PHYSICIAN ASSISTANT STUDIES
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0001
Country	:	US
Telephone Number	:	352-265-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 SW 16TH ST
Second Line	:	SUITE 1160
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1128
Country	:	US
Telephone Number	:	352-265-7955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	04/25/2013

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