Healthcare Provider Details

I. General information

NPI: 1750378311
Provider Name (Legal Business Name): THOMAS M SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 13TH AVE S STE 215
JACKSONVILLE BEACH FL
32250-3206
US

IV. Provider business mailing address

PO BOX 746649
ATLANTA GA
30374-6649
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-1041
  • Fax: 904-249-9764
Mailing address:
  • Phone: 904-376-4400
  • Fax: 904-391-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME55794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: