Healthcare Provider Details

I. General information

NPI: 1205899317
Provider Name (Legal Business Name): IRVIN J SNYDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 61
RIPLEY WV
25271-9710
US

IV. Provider business mailing address

RR 1 BOX 61
RIPLEY WV
25271-9710
US

V. Phone/Fax

Practice location:
  • Phone: 304-372-7617
  • Fax: 304-372-7619
Mailing address:
  • Phone: 304-372-7617
  • Fax: 304-372-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1413
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: