MEDICARE: DR. NORMAN I SNYDER 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	2084P0804X	Child & Adolescent Psychiatry Physician	R4362	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55757	OTHER	AR	BLUE CROSS
2	13034000000	OTHER	AR	QUALCHOICE QCA

General Provider Information

NPI Number	:	1689617417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN I SNYDER MD

Provider Business Mailing Address
First Line	:	4253 N CROSSOVER RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4593
Country	:	US
Telephone Number	:	479-442-8577
Fax Number	:	479-442-2563

Provider Business Practice Location Address
First Line	:	4253 N CROSSOVER RD
Second Line	:	SUITE 2
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4593
Country	:	US
Telephone Number	:	479-442-8577
Fax Number	:	479-442-2563

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/10/2007

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