Healthcare Provider Details

I. General information

NPI: 1871053264
Provider Name (Legal Business Name): KENNETH WILLIAM SNYDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 INNOVATION DR
RENO NV
89511-2215
US

IV. Provider business mailing address

300 E 2ND ST STE 1230
RENO NV
89501-1587
US

V. Phone/Fax

Practice location:
  • Phone: 775-553-0476
  • Fax:
Mailing address:
  • Phone: 775-312-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO3346
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: