Healthcare Provider Details

I. General information

NPI: 1407059058
Provider Name (Legal Business Name): SEAN M SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST FL 4
MISSOULA MT
59802-4008
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-1940
  • Fax: 406-327-1974
Mailing address:
  • Phone: 406-327-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60199078
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60199078
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMED-PHYS-LIC-88718
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: