Healthcare Provider Details

I. General information

NPI: 1013946706
Provider Name (Legal Business Name): KEVIN K. SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

IV. Provider business mailing address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-9703
  • Fax: 719-631-7017
Mailing address:
  • Phone: 719-373-9703
  • Fax: 719-631-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number41126
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41126
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: