Healthcare Provider Details

I. General information

NPI: 1649677436
Provider Name (Legal Business Name): KEVIN SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2014
Last Update Date: 11/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30466 SGT E I BOOTS THOMAS DR SUITE 206A
SPANISH FORT AL
36527-7630
US

IV. Provider business mailing address

30466 SGT E I BOOTS THOMAS DR SUITE 206A
SPANISH FORT AL
36527-7630
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-4605
  • Fax: 251-517-1014
Mailing address:
  • Phone: 251-626-4605
  • Fax: 251-517-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: