Provider Demographics
NPI:1164480521
Name:SNYDER, RON (IDC)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:GLENN
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:BRAVO CO, 3D MEDICAL BN, 3D MLG
Mailing Address - Street 2:UNIT 38448
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8448
Mailing Address - Country:JP
Mailing Address - Phone:01181611-723-6059
Mailing Address - Fax:
Practice Address - Street 1:BRAVO CO, 3D MEDICAL BN, 3D MLG
Practice Address - Street 2:UNIT 38448
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8448
Practice Address - Country:JP
Practice Address - Phone:01181611-723-6059
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman