Provider Demographics
NPI:1063458016
Name:SNYDER, GARY LEE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PATTERSON RD
Mailing Address - Street 2:STE 605
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506
Mailing Address - Country:US
Mailing Address - Phone:970-244-2482
Mailing Address - Fax:970-255-1701
Practice Address - Street 1:425 PATTERSON RD
Practice Address - Street 2:STE 605
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506
Practice Address - Country:US
Practice Address - Phone:970-244-2482
Practice Address - Fax:970-255-1701
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO22555207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01225556Medicaid
COC03504Medicare UPIN
CO01225556Medicaid
COCE2224Medicare PIN