Healthcare Provider Details

I. General information

NPI: 1295730349
Provider Name (Legal Business Name): GREGORY BRUCE SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD STE 190
ST LOUIS PARK MN
55416-2627
US

IV. Provider business mailing address

MEDICAL SCANNING CONSULTANTS. PA. 5775 WAYZATA BLVD. SUITE 400
ST. LOUIS PARK MN
55416
US

V. Phone/Fax

Practice location:
  • Phone: 952-541-1840
  • Fax:
Mailing address:
  • Phone: 952-905-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-2507
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38581
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number38581
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number45851-20
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMTL-2025-010
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: