Basic Information
| Provider Information | |||||||||
| NPI: | 1891721635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | PRESTON | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9621 RIDGETOP BLVD NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838502 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 3607823689 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 NW MYHRE RD | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983837681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608301100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 03/08/2018 | ||||||||
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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 | 207YS0123X | MD00027214 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YX0007X | MD00027214 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | 207Y00000X | MD00027214 | WA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 4510963 | 01 | AETNA | OTHER | 8117863 | 05 | WA | MEDICAID | RI6563 | 01 | REGENCE BLUESHIELD | OTHER | BR0274922 | 01 | DEA | OTHER | 040002989 | 01 | RAILROAD MEDICARE | OTHER | 8913531 | 01 | WA | CRIME VICTIM COMP | OTHER | 75445 | 01 | WA | LABOR & INDUSTRIES | OTHER |