Healthcare Provider Details

I. General information

NPI: 1124007653
Provider Name (Legal Business Name): NOLAN C. SNIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 S NATIONAL AVE STE 207
SPRINGFIELD MO
65807-7315
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-9220
  • Fax: 417-269-9229
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number105783
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: