MEDICARE: DR. GEORGE JACKSON SNIPES JR. M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	L5567	TX
2	207ZN0500X	Neuropathology Physician	L5567	TX

General Provider Information

NPI Number	:	1508861527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE JACKSON SNIPES JR. M.D.

Provider Business Mailing Address
First Line	:	3600 GASTON AVE
Second Line	:	BARNETT TOWER, #707
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-823-6492
Fax Number	:	214-818-9180

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	WADLEY TOWER, #261
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-823-6492
Fax Number	:	214-818-9180

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/23/2008

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