Healthcare Provider Details

I. General information

NPI: 1750342739
Provider Name (Legal Business Name): DAVID ALAN SNYDERMAN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S LA CASSIA DR
BOISE ID
83705-2253
US

IV. Provider business mailing address

PO BOX 9 211 16TH AVE N
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-0086
  • Fax: 208-466-5359
Mailing address:
  • Phone: 208-467-4431
  • Fax: 208-467-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA286
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-286
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: