Healthcare Provider Details

I. General information

NPI: 1558680587
Provider Name (Legal Business Name): BRIAN DOXEY SNOW D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 E FLAMINGO AVE STE 340
NAMPA ID
83687-9306
US

IV. Provider business mailing address

3525 E LOUISE DR STE 195
MERIDIAN ID
83642-6303
US

V. Phone/Fax

Practice location:
  • Phone: 208-846-8335
  • Fax: 208-846-8336
Mailing address:
  • Phone: 208-846-8335
  • Fax: 208-472-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number012787
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberO-1209
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102202953
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: