MEDICARE: DR. W. RANDY SNYDER DDS, MS

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	1223E0200X	Endodontics	17165	TX

General Provider Information

NPI Number	:	1528187960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. W. RANDY SNYDER DDS, MS

Provider Business Mailing Address
First Line	:	3131 GREEN MEADOW DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6977
Country	:	US
Telephone Number	:	325-947-3636
Fax Number	:	325-942-7594

Provider Business Practice Location Address
First Line	:	3131 GREEN MEADOW DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6977
Country	:	US
Telephone Number	:	325-947-3636
Fax Number	:	325-942-7594

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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