Healthcare Provider Details

I. General information

NPI: 1851337984
Provider Name (Legal Business Name): GRADY KING SNYDER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 ALPINE DR
CASPER WY
82601-5917
US

IV. Provider business mailing address

3443 ALPINE DR
CASPER WY
82601-5917
US

V. Phone/Fax

Practice location:
  • Phone: 307-441-1026
  • Fax:
Mailing address:
  • Phone: 307-441-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101286323
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9504A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27626
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: