Healthcare Provider Details

I. General information

NPI: 1609107309
Provider Name (Legal Business Name): MICHAEL GENE SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18225 LEGION RD
FRENCH SETTLEMENT LA
70733-2215
US

IV. Provider business mailing address

18225 LEGION RD
FRENCH SETTLEMENT LA
70733-2215
US

V. Phone/Fax

Practice location:
  • Phone: 225-279-0284
  • Fax: 225-698-9619
Mailing address:
  • Phone: 225-279-0284
  • Fax: 225-698-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number553877
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: