Healthcare Provider Details

I. General information

NPI: 1962797126
Provider Name (Legal Business Name): BRIAN JOHN SNYDERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 05/16/2021
Certification Date: 05/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S NEW BALLAS RD STE 7020
SAINT LOUIS MO
63141-8218
US

IV. Provider business mailing address

1603 DEARBORN DR
SAINT LOUIS MO
63122-1713
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6486
  • Fax:
Mailing address:
  • Phone: 573-465-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2016008713
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: