Provider Demographics
NPI:1154446631
Name:RICE, JOSEPH C (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:RICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:345 N SHORE CIR
Mailing Address - Street 2:#1226
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2779
Mailing Address - Country:US
Mailing Address - Phone:617-710-1053
Mailing Address - Fax:904-217-8057
Practice Address - Street 1:1 ORTHOPAEDIC PL
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4202
Practice Address - Country:US
Practice Address - Phone:904-825-0540
Practice Address - Fax:904-217-8057
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1061363AS0400X
FLPA9105420363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGI965ZMedicare PIN
MARIAP1215Medicare ID - Type UnspecifiedPHYSICIAN ASSISTANT
MAP00547Medicare UPIN