Healthcare Provider Details

I. General information

NPI: 1225520521
Provider Name (Legal Business Name): JACOB WILLIAM SNYDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOSPITAL DR
ATHENS OH
45701-2302
US

IV. Provider business mailing address

20000 HARVARD AVE
WARRENSVILLE HEIGHTS OH
44122-6805
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-5991
  • Fax:
Mailing address:
  • Phone: 216-491-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.015315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: