MEDICARE: MARCUS STEFAN SNYDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01061038A	IN

General Provider Information

NPI Number	:	1043209026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS STEFAN SNYDER MD

Provider Business Mailing Address
First Line	:	755 SCOTT CIRCLE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 SCOTT CIRCLE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818
Country	:	US
Telephone Number	:	808-448-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	04/24/2018

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