Healthcare Provider Details

I. General information

NPI: 1922151406
Provider Name (Legal Business Name): ADAM C SNYDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 N MUSKOGEE PL
CLAREMORE OK
74017-3058
US

IV. Provider business mailing address

1202 N MUSKOGEE PL
CLAREMORE OK
74017-3058
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4456
  • Fax: 918-392-4465
Mailing address:
  • Phone: 918-392-4456
  • Fax: 918-392-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number77097
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: