Healthcare Provider Details

I. General information

NPI: 1336241868
Provider Name (Legal Business Name): JANE ELIZABETH SNOW M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA SNOW M.D.

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 MIDDLEFIELD RD
BERKELEY CA
94708-1748
US

IV. Provider business mailing address

1027 MIDDLEFIELD RD
BERKELEY CA
94708-1748
US

V. Phone/Fax

Practice location:
  • Phone: 510-507-4401
  • Fax: 510-588-4840
Mailing address:
  • Phone: 510-507-4401
  • Fax: 510-588-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA22573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: