Healthcare Provider Details

I. General information

NPI: 1447419320
Provider Name (Legal Business Name): JASON ANDREW SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DIV SURG ACCS, STE 420
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8109-43-1160
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5298
  • Fax: 314-362-5743
Mailing address:
  • Phone: 314-747-2829
  • Fax: 314-362-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number2016012363
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036146873
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number2016012363
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036146873
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036146873
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2016012363
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: