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General NPI Number Information
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NPI Number | 1932157260
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Entity Type | Individual
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Provider Name | BRENT MICHAEL SNADER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 2861 BROAD AVE
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City | MEMPHIS
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State | TN
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Zip | 38112-2903
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Country | US
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Telephone | 901-260-8500
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Fax | 901-325-6469
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Provider Business Mailing Address
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Address Line | 2953 BROAD AVE
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City | MEMPHIS
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State | TN
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Zip | 38112-2957
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Country | US
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Telephone | 901-260-8500
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Fax | 901-260-8599
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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 | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | MD0000038188
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License Number State | TN
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