=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730362484
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANA SNELL, D.O. P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 03/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3912 N TARRANT PKWY STE 204
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76244-5410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-431-2600
-----------------------------------------------------
Fax | 817-431-2669
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3912 N TARRANT PKWY STE 204
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76244-5410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-431-2600
-----------------------------------------------------
Fax | 817-431-2669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DR. DANA SNELL
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 817-431-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | L8511
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------