=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669428736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WALTER M SNIHUROWYCH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 05/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 N FAIRGROUNDS RD
-----------------------------------------------------
City | PRICE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84501-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-637-4048
-----------------------------------------------------
Fax | 435-636-0171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 964
-----------------------------------------------------
City | PRICE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84501-0964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-637-4048
-----------------------------------------------------
Fax | 435-636-0171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 163736-1205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------