MEDICARE: DR. ORRENZO BENALLY SNYDER 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	208800000X	Urology Physician	C172411	CA
2	208800000X	Urology Physician	6844039-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720171259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ORRENZO BENALLY SNYDER M.D.

Provider Business Mailing Address
First Line	:	263 PEARSON DR STE 100
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-3333
Country	:	US
Telephone Number	:	559-772-4301
Fax Number	:	559-772-4302

Provider Business Practice Location Address
First Line	:	263 PEARSON DR STE 100
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-3333
Country	:	US
Telephone Number	:	559-772-4301
Fax Number	:	559-772-4302

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/29/2022

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Directions to “ DR. ORRENZO BENALLY SNYDER M.D.” Practice Location

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