Healthcare Provider Details

I. General information

NPI: 1962470302
Provider Name (Legal Business Name): JAMES R SNYDER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BEAM AVE SUITE 302
MAPLEWOOD MN
55109-1163
US

IV. Provider business mailing address

11901 LOFTON AVE S
HASTINGS MN
55033-8408
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7831
  • Fax: 651-232-7826
Mailing address:
  • Phone: 651-438-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8918
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: