Provider Demographics
NPI:1043270044
Name:SNODGRASS, GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:SNODGRASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 NW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4777
Mailing Address - Country:US
Mailing Address - Phone:352-373-4300
Mailing Address - Fax:352-372-1641
Practice Address - Street 1:4313 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4777
Practice Address - Country:US
Practice Address - Phone:352-373-4300
Practice Address - Fax:352-372-1641
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0458422000Medicaid
FL02963OtherBLUE CROSS BLUE SHIELD
FLEXF39OtherBLUE CROSS BLUE SHIELD
FL5329094OtherAETNA
FL5329094OtherAETNA
FL1108800003Medicare NSC
FL02963WMedicare PIN
FL02963XMedicare PIN
FL02963OtherBLUE CROSS BLUE SHIELD
FLEXF39OtherBLUE CROSS BLUE SHIELD
FL0458422000Medicaid