Healthcare Provider Details

I. General information

NPI: 1629071675
Provider Name (Legal Business Name): ALEX SNEIDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE AVE
FARIBAULT MN
55021-6319
US

IV. Provider business mailing address

924 1ST ST NE
FARIBAULT MN
55021-5441
US

V. Phone/Fax

Practice location:
  • Phone: 507-333-3200
  • Fax: 507-333-3211
Mailing address:
  • Phone: 507-333-3000
  • Fax: 507-333-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00033295
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number31957
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: