Healthcare Provider Details

I. General information

NPI: 1053617464
Provider Name (Legal Business Name): BRADLEY WILLIAM SNYDER IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7224 NORTH 139TH AVENUE
GLENDALE AZ
85309
US

IV. Provider business mailing address

8260 W PURDUE AVE
PEORIA AZ
85345-3140
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-9742
  • Fax:
Mailing address:
  • Phone: 480-710-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: