Healthcare Provider Details

I. General information

NPI: 1538267059
Provider Name (Legal Business Name): RANDALL WILLIAM SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 WINKLER AVENUE EXT
FORT MYERS FL
33916-9413
US

IV. Provider business mailing address

139 APRIL SOUND DR
NAPLES FL
34119-1353
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-3939
  • Fax: 239-931-6114
Mailing address:
  • Phone: 239-939-3939
  • Fax: 239-931-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD011306E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: