MEDICARE: MICHAEL RAY SNEDECOR MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	H4711	TX

General Provider Information

NPI Number	:	1033104237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RAY SNEDECOR MD, MPH

Provider Business Mailing Address
First Line	:	8422 WENDELL DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-2156
Country	:	US
Telephone Number	:	703-927-7193
Fax Number	:	703-228-9037

Provider Business Practice Location Address
First Line	:	8422 WENDELL DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-2156
Country	:	US
Telephone Number	:	703-927-7193
Fax Number	:	703-228-9037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	11/06/2009

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