Provider Demographics
NPI:1154447399
Name:JAMES W SNYDER DIABETES ENDOCRINOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:JAMES W SNYDER DIABETES ENDOCRINOLOGY CONSULTANTS, PC
Other - Org Name:DIABETES & ENDOCRINOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-362-3422
Mailing Address - Street 1:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89125-1548
Mailing Address - Country:US
Mailing Address - Phone:702-671-6850
Mailing Address - Fax:702-671-6855
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:STE 418
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-796-7256
Practice Address - Fax:702-696-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207RE0101X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105343Medicare PIN