MEDICARE: JACOB L SNOW 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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	15891	NV

General Provider Information

NPI Number	:	1730321100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB L SNOW M.D.

Provider Business Mailing Address
First Line	:	3131 LA CANADA ST
Second Line	:	SUITE 244
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2578
Country	:	US
Telephone Number	:	702-697-5234
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 LA CANADA ST
Second Line	:	SUITE 244
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2578
Country	:	US
Telephone Number	:	702-697-5234
Fax Number	:

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

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	09/02/2015

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