Healthcare Provider Details

I. General information

NPI: 1790352185
Provider Name (Legal Business Name): JASON OWEN SNYDER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 S 1000 E STE 102
SANDY UT
84094-5421
US

IV. Provider business mailing address

11333 S 1000 E STE 102
SANDY UT
84094-5421
US

V. Phone/Fax

Practice location:
  • Phone: 801-462-2205
  • Fax: 801-748-1030
Mailing address:
  • Phone: 801-462-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12234294-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: