Healthcare Provider Details

I. General information

NPI: 1518979426
Provider Name (Legal Business Name): JEAN MARIE SNYDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN MARIE HAYES

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE ST STE 101
ANCHORAGE AK
99508-5444
US

IV. Provider business mailing address

PO BOX 4105
PORTLAND OR
97208-4105
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-4400
  • Fax: 907-212-4401
Mailing address:
  • Phone: 866-907-1068
  • Fax: 425-917-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3241
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: