Healthcare Provider Details

I. General information

NPI: 1164480521
Provider Name (Legal Business Name): RON SNYDER IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: RONALD GLENN SNYDER IDC

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRAVO CO, 3D MEDICAL BN, 3D MLG UNIT 38448
FPO AP
96604-8448
JP

IV. Provider business mailing address

BRAVO CO, 3D MEDICAL BN, 3D MLG UNIT 38448
FPO AP
96604-8448
JP

V. Phone/Fax

Practice location:
  • Phone: 011816117236059
  • Fax:
Mailing address:
  • Phone: 011816117236059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: