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General NPI Number Information
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NPI Number | 1902454358
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Entity Type | Individual
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Provider Name | MICHAEL TRAVIS SNIDER PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE BLDG 3
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5599
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Fax | 228-523-4526
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Provider Business Mailing Address
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Address Line | 830 US HIGHWAY 98 APT 832
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City | DAPHNE
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State | AL
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Zip | 36526-5812
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Country | US
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Telephone | 850-582-1507
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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