Provider Demographics
NPI:1033173919
Name:SNYDER, R SCOTT (MD)
Entity Type:Individual
Prefix:MRS
First Name:R
Middle Name:SCOTT
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMON
Other - Middle Name:SCOTT
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 20609
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-8609
Mailing Address - Country:US
Mailing Address - Phone:510-690-0558
Mailing Address - Fax:510-690-1894
Practice Address - Street 1:20101A LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5305
Practice Address - Country:US
Practice Address - Phone:510-690-0558
Practice Address - Fax:510-690-1894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00*21465261OtherMCARE PIN
CAF62767Medicare UPIN
CAOOA465261Medicare ID - Type UnspecifiedMEDICARE ID