Healthcare Provider Details

I. General information

NPI: 1992950398
Provider Name (Legal Business Name): MR. ROBERT JOSEPH SNIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINDA VISTA DR
BELLEVILLE IL
62221-4067
US

IV. Provider business mailing address

1 LINDA VISTA DR
BELLEVILLE IL
62221-4067
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-6645
  • Fax:
Mailing address:
  • Phone: 314-894-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: