Healthcare Provider Details

I. General information

NPI: 1548331226
Provider Name (Legal Business Name): BRUCE ALAN SNIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 GRAVES AVE STE 210
ERLANGER KY
41018-3309
US

IV. Provider business mailing address

510 GRAVES AVE STE 210
ERLANGER KY
41018-3309
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-5014
  • Fax: 859-341-5136
Mailing address:
  • Phone: 859-341-5014
  • Fax: 859-341-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16835
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16835
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: