MEDICARE: DR. REGINALD DIETEL RICE JR. 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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	G70357	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G703570	OTHER	CA	STATE PHYSICIAN LICENSE #

General Provider Information

NPI Number	:	1710936976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINALD DIETEL RICE JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 45680
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94145-0680
Country	:	US
Telephone Number	:	530-344-2000
Fax Number	:	530-344-2014

Provider Business Practice Location Address
First Line	:	4300 GOLDEN CENTER DR
Second Line	:	SUITE D
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6278
Country	:	US
Telephone Number	:	530-344-2000
Fax Number	:	530-344-2014

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	01/12/2016

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