Healthcare Provider Details

I. General information

NPI: 1588654503
Provider Name (Legal Business Name): FREDERICK SNYDER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

9705 PORT HURON LN
LAS VEGAS NV
89134-0423
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-3040
  • Fax: 702-653-2115
Mailing address:
  • Phone: 702-792-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: