Provider Demographics
NPI:1306176235
Name:RICE, LEVI ANDREW JR (DO)
Entity type:Individual
Prefix:DR
First Name:LEVI
Middle Name:ANDREW
Last Name:RICE
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:221 W. COLORADO BLVD.
Mailing Address - Street 2:PAVILION II SUITE 831
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-933-7430
Mailing Address - Fax:214-947-8609
Practice Address - Street 1:1 MERCADO ST STE 130
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-247-1120
Practice Address - Fax:970-247-1128
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2024-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN5359207RC0000X, 207RI0011X, 207RI0011X
CODR.0061835207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342542302Medicaid
CO9000171139Medicaid