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NPI Code Detail

MEDICARE: DR. BOYD D SNELLGROVE MD

MEDICARE: DR. BOYD D SNELLGROVE 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
12085R0202XDiagnostic Radiology Physician022007LA

Other Identifiers

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

General Provider Information

NPI Number : 1811942808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BOYD D SNELLGROVE MD
Provider Business Mailing Address
First Line : PO BOX 9774
Second Line :
City : NEW IBERIA
State : LA
Zip : 70562-9774
Country : US
Telephone Number : 337-367-1048
Fax Number : 337-367-0131
Provider Business Practice Location Address
First Line : 2315 E MAIN ST
Second Line :
City : NEW IBERIA
State : LA
Zip : 70560-4031
Country : US
Telephone Number : 337-367-1048
Fax Number : 337-367-0131
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 03/28/2008

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Directions to “ DR. BOYD D SNELLGROVE MD” Practice Location

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