Provider Demographics
NPI:1992902019
Name:RICE, MICHAEL W (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:RICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17192 US HIGHWAY 27 LOT 165
Mailing Address - Street 2:
Mailing Address - City:MOORE HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33471-5539
Mailing Address - Country:US
Mailing Address - Phone:239-851-3157
Mailing Address - Fax:
Practice Address - Street 1:17192 US HIGHWAY 27 LOT 165
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471-5539
Practice Address - Country:US
Practice Address - Phone:239-851-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant