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General NPI Number Information
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NPI Number | 1760696918
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Entity Type | Individual
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Provider Name | BRETT T SNODGRASS MD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 1 SOUTHTOWNE DR. GREAT MINES HEALTH CENTER
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City | POTOSI
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State | MO
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Zip | 63664
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Country | US
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Telephone | 573-438-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 100A KENRICK PLAZA JULIE THOMAS
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City | ST. LOUIS
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State | MO
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Zip | 63119-4416
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Country | US
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Telephone | 314-968-0076
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Fax | 314-968-6883
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2008015989
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License Number State | MO
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