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NPI Code Detail

MEDICARE: DR. ERIC SNOOK D.P.M.

MEDICARE:  DR. ERIC  SNOOK  D.P.M.
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
1213ES0103XFoot & Ankle Surgery Podiatrist016005090IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00785898OTHERILRAILROAD MEDICARE PTAN

General Provider Information

NPI Number : 1710974787
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC SNOOK D.P.M.
Provider Business Mailing Address
First Line : 2900 FRANK SCOTT PKWY W
Second Line : SUITE 900
City : BELLEVILLE
State : IL
Zip : 62223-5000
Country : US
Telephone Number : 618-277-5700
Fax Number : 618-257-7049
Provider Business Practice Location Address
First Line : 2900 FRANK SCOTT PKWY W
Second Line : SUITE 900
City : BELLEVILLE
State : IL
Zip : 62223-5000
Country : US
Telephone Number : 618-277-5700
Fax Number : 618-257-7049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 12/31/2020

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