=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306967005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNETH R. SNYDER, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11162 OSPREY LAKE LN
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33412-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-321-5070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11162 OSPREY LAKE LN
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33412-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-321-5070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. KENNETH RICHARD SNYDER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 772-321-5070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0070209
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------