Healthcare Provider Details

I. General information

NPI: 1558322453
Provider Name (Legal Business Name): DAVID BRIAN SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST SUITE 375
PORTLAND OR
97227-1654
US

IV. Provider business mailing address

501 N GRAHAM ST SUITE 375
PORTLAND OR
97227-1654
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-1600
  • Fax: 503-413-1915
Mailing address:
  • Phone: 503-413-1600
  • Fax: 503-413-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD15688
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: