Basic Information
| Provider Information | |||||||||
| NPI: | 1295782126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | Z | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 DATAPOINT, SUITE 600 | ||||||||
| Address2: | P. O. BOX 29441 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782290441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167796 | ||||||||
| FaxNumber: | 2106167799 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 DATAPOINT DR STE 600 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167796 | ||||||||
| FaxNumber: | 2106167799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Q6693 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P01577350 | 01 | TX | RAILROAD MEDICARE | OTHER | P01577827 | 01 | TX | RAILROAD MEDICARE | OTHER | 3520900-03 | 05 | TX | MEDICAID | Q6693 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER | 3520900-01 | 05 | TX | MEDICAID | 3520900-02 | 05 | TX | MEDICAID |