Healthcare Provider Details

I. General information

NPI: 1598746752
Provider Name (Legal Business Name): ROGER OWEN SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BANEY RD S ASHLAND FAMILY PRACTICE/SAMARITAN PROFESSIONAL CORP
ASHLAND OH
44805-4502
US

IV. Provider business mailing address

PO BOX 72098
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 419-289-0333
  • Fax: 419-281-7903
Mailing address:
  • Phone: 419-289-0333
  • Fax: 419-281-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: