MEDICARE: DR. BRENDA A SNOWMAN MD

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	207V00000X	Obstetrics & Gynecology Physician	MD023514	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0157720	OTHER	TN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235117250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA A SNOWMAN MD

Provider Business Mailing Address
First Line	:	2550 BUSINESS PARK DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-6503
Country	:	US
Telephone Number	:	423-339-8881
Fax Number	:	423-464-6126

Provider Business Practice Location Address
First Line	:	2550 BUSINESS PARK DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-6503
Country	:	US
Telephone Number	:	423-339-8881
Fax Number	:	423-464-6126

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	03/16/2015

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