Healthcare Provider Details

I. General information

NPI: 1578507059
Provider Name (Legal Business Name): JON F SNOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 S NATIONAL AVE STE 101
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-9950
  • Fax: 417-269-9959
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR7E55
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberR7E55
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: