Provider Demographics
NPI:1154380483
Name:TICE, DONALD W (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:TICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:141 HILDEN RD STE 201
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8400
Practice Address - Country:US
Practice Address - Phone:904-825-1941
Practice Address - Fax:904-390-7460
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-03-05
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Provider Licenses
StateLicense IDTaxonomies
FLOS19428207Q00000X
NVD01509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine