Healthcare Provider Details

I. General information

NPI: 1679564009
Provider Name (Legal Business Name): RONALD G. SNYDER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MISSOURI AVE GLWACH-ATTN MCXP-CCS-CR
FORT LEONARD WOOD MO
65473-8952
US

IV. Provider business mailing address

126 MISSOURI AVE GLWACH-ATTN MCXP-CCS-CR
FORT LEONARD WOOD MO
65473-8952
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0417
  • Fax: 573-596-0524
Mailing address:
  • Phone: 573-596-0417
  • Fax: 573-596-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number104126
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: