Provider Demographics
NPI:1194856542
Name:SNYDER, SUSAN JANE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JANE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3533
Mailing Address - Country:US
Mailing Address - Phone:515-274-1518
Mailing Address - Fax:515-274-6916
Practice Address - Street 1:4116 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3533
Practice Address - Country:US
Practice Address - Phone:515-274-1518
Practice Address - Fax:515-274-6916
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4286A207Q00000X
IA3882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1194856542Medicaid
WY118733300Medicaid
WYE58540Medicare UPIN
WY118733300Medicaid
IA71926061Medicare PIN