Healthcare Provider Details

I. General information

NPI: 1073715090
Provider Name (Legal Business Name): DANIEL DALLEY SNELL M.D, M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HOSPITAL WAY
POCATELLO ID
83201-5175
US

IV. Provider business mailing address

PO BOX 4107
POCATELLO ID
83205-4107
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-7760
  • Fax: 208-232-1950
Mailing address:
  • Phone: 208-232-7760
  • Fax: 208-232-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number76558
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM-10006
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: