MEDICARE: DR. IRA LAWRENCE SNIDER DO

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	208D00000X	General Practice Physician	4745	AZ
2	208D00000X	General Practice Physician	L1417691	MI

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

General Provider Information

NPI Number	:	1992039093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA LAWRENCE SNIDER DO

Provider Business Mailing Address
First Line	:	1343 N ALMA SCHOOL RD
Second Line	:	STE 160
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5901
Country	:	US
Telephone Number	:	480-963-1853
Fax Number	:	480-963-1854

Provider Business Practice Location Address
First Line	:	4222 N 12TH ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-6023
Country	:	US
Telephone Number	:	602-265-4357
Fax Number	:	602-604-9352

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	03/22/2019

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