Healthcare Provider Details

I. General information

NPI: 1144387242
Provider Name (Legal Business Name): JOHN M. SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 PROVIDENCE DR 457
ANCHORAGE AK
99508-4628
US

IV. Provider business mailing address

3340 PROVIDENCE DR 457
ANCHORAGE AK
99508-4628
US

V. Phone/Fax

Practice location:
  • Phone: 907-333-8854
  • Fax: 907-337-3226
Mailing address:
  • Phone: 907-333-8854
  • Fax: 907-337-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1131
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: