Healthcare Provider Details

I. General information

NPI: 1306872999
Provider Name (Legal Business Name): MICHAEL J SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST
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: 406-728-2539
  • Fax: 406-728-2709
Mailing address:
  • Phone: 406-728-2539
  • Fax: 406-728-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7742
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: