Healthcare Provider Details

I. General information

NPI: 1720188105
Provider Name (Legal Business Name): STEPHEN R SNYDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 14TH
PONCA CITY OK
74602
US

IV. Provider business mailing address

PO BOX 1547
SEDALIA MO
65302
US

V. Phone/Fax

Practice location:
  • Phone: 580-765-0428
  • Fax:
Mailing address:
  • Phone: 660-826-5960
  • Fax: 660-826-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0029101
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: