Healthcare Provider Details

I. General information

NPI: 1629155130
Provider Name (Legal Business Name): WAYNE SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 E STATE ROAD 44
FRANKLIN IN
46131-9199
US

IV. Provider business mailing address

990 E STATE ROAD 44
FRANKLIN IN
46131-9199
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-8474
  • Fax: 317-736-6040
Mailing address:
  • Phone: 317-736-8474
  • Fax: 317-736-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01037669
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: