Healthcare Provider Details

I. General information

NPI: 1730599978
Provider Name (Legal Business Name): JASON SNYDER IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS MOBILE BAY CG 53
FPO AP
96672-1173
US

IV. Provider business mailing address

USS MOBILE BAY CG 53
FPO AP
96672-1173
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-4509
  • Fax:
Mailing address:
  • Phone: 619-556-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: