Provider Demographics
NPI:1003095738
Name:RICHARD A. SNIDER, MD, PC
Entity Type:Organization
Organization Name:RICHARD A. SNIDER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-893-2644
Mailing Address - Street 1:12010 S WARNER ELLIOT LOOP
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-2731
Mailing Address - Country:US
Mailing Address - Phone:480-893-2644
Mailing Address - Fax:
Practice Address - Street 1:12010 S WARNER ELLIOT LOOP
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-2731
Practice Address - Country:US
Practice Address - Phone:480-893-2644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71638Medicare PIN