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NPI Code Detail

MEDICARE: ETHAN ROBERT SNOWDEN

MEDICARE: ETHAN ROBERT SNOWDEN
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
1363A00000XPhysician Assistant350988LA

General Provider Information

NPI Number : 1902752009
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN ROBERT SNOWDEN
Provider Business Mailing Address
First Line : 2301 TIMBERLINE CT APT D108
Second Line :
City : RUSTON
State : LA
Zip : 71270-5286
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1501 LOUISVILLE AVE
Second Line :
City : MONROE
State : LA
Zip : 71201-6025
Country : US
Telephone Number : 318-323-8451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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Directions to “ ETHAN ROBERT SNOWDEN ” Practice Location

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