Healthcare Provider Details

I. General information

NPI: 1881795268
Provider Name (Legal Business Name): EDGAR HOWARD SNIDER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3498
US

IV. Provider business mailing address

PO BOX 917156
ORLANDO FL
32891-7156
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1000
  • Fax: 904-346-0113
Mailing address:
  • Phone: 407-292-0039
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0002867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: