Healthcare Provider Details

I. General information

NPI: 1679623805
Provider Name (Legal Business Name): CHRISTOPHER H. SNYDER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST SUITE 560
SPRINGFIELD MO
65807-5154
US

IV. Provider business mailing address

212 E NOTTINGHAM LN
SPRINGFIELD MO
65810-2629
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-1600
  • Fax: 417-882-1302
Mailing address:
  • Phone: 417-882-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2B64
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier232264
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBLUE CHOICE INSURANCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: