Basic Information
| Provider Information | |||||||||
| NPI: | 1174519805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | ELVON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5398 PARK ST N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337091041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275441441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5398 PARK ST N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337091041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275441441 | ||||||||
| FaxNumber: | 7275458263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA2902 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.