Healthcare Provider Details

I. General information

NPI: 1043300551
Provider Name (Legal Business Name): JON F SNIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

PO BOX 2989
COLORADO SPRINGS CO
80901-2989
US

V. Phone/Fax

Practice location:
  • Phone: 719-593-1799
  • Fax: 719-265-3794
Mailing address:
  • Phone: 719-593-1799
  • Fax: 719-265-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number31468
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: