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General NPI Number Information
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NPI Number | 1629573589
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Entity Type | Individual
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Provider Name | JOSEPH MATTHEW SNIDER MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 215 CENTRAL AVE STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40208-1450
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Country | US
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Telephone | 502-588-8720
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Fax |
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Provider Business Mailing Address
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Address Line | 201 ABRAHAM FLEXNER WAY STE 690
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City | LOUISVILLE
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State | KY
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Zip | 40202-3841
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R5602
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License Number State | KY
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