Healthcare Provider Details

I. General information

NPI: 1053428466
Provider Name (Legal Business Name): BRETT J. SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 PONTE VEDRA PARK DR
PONTE VEDRA BEACH FL
32082-6600
US

IV. Provider business mailing address

209 PONTE VEDRA PARK DR
PONTE VEDRA BEACH FL
32082-6600
US

V. Phone/Fax

Practice location:
  • Phone: 904-273-6200
  • Fax: 904-280-8013
Mailing address:
  • Phone: 904-273-6200
  • Fax: 904-280-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME81679
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME81679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: