Healthcare Provider Details

I. General information

NPI: 1891144697
Provider Name (Legal Business Name): DOUGLAS WILLIAM SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 01/09/2023
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE 6TH FL
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8096
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3937
  • Fax: 314-362-3725
Mailing address:
  • Phone: 314-362-3937
  • Fax: 314-362-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number2022019831
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: