MEDICARE: IRA H. REX III M.D.

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	174400000X	Specialist	76995	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2221266	OTHER	MA	AETNA US HEALTHCARE
2	491294	OTHER	MA	US HEALTH
3	797314	OTHER	MA	TUFTS HEALTH PLAN
4	0019396	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
5	21215	OTHER	MA	HARVARD PILGRIM HEALTH
6	M17366	OTHER	MA	BLUE CROSS BLUE SHIELD
7	204281	OTHER	RI	BLUECHIP
8	4833-8	OTHER	RI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1609870112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRA H. REX III M.D.

Provider Business Mailing Address
First Line	:	10 N MAIN ST
Second Line	:	FL 3
City	:	FALL RIVER
State	:	MA
Zip	:	02720-2130
Country	:	US
Telephone Number	:	508-674-6100
Fax Number	:	508-674-6197

Provider Business Practice Location Address
First Line	:	10 N MAIN ST
Second Line	:	FL 3
City	:	FALL RIVER
State	:	MA
Zip	:	02720-2130
Country	:	US
Telephone Number	:	508-674-6100
Fax Number	:	508-674-6197

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/11/2014

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