Healthcare Provider Details

I. General information

NPI: 1063458016
Provider Name (Legal Business Name): GARY LEE SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PATTERSON RD STE 605
GRAND JUNCTION CO
81506
US

IV. Provider business mailing address

425 PATTERSON RD STE 605
GRAND JUNCTION CO
81506
US

V. Phone/Fax

Practice location:
  • Phone: 970-244-2482
  • Fax: 970-255-1701
Mailing address:
  • Phone: 970-244-2482
  • Fax: 970-255-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22555
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: