Provider Demographics
NPI:1114966363
Name:SNODGRASS, PRISCILLA CARTER (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:CARTER
Last Name:SNODGRASS
Suffix:
Gender:F
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:PO BOX 6248
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-6248
Mailing Address - Country:US
Mailing Address - Phone:806-771-5550
Mailing Address - Fax:806-771-5511
Practice Address - Street 1:3801 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-3859
Practice Address - Country:US
Practice Address - Phone:806-771-5550
Practice Address - Fax:806-771-5511
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6101207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129149406Medicaid
TX129149406Medicaid
TXF54239Medicare UPIN