Provider Demographics
NPI:1215034491
Name:SNOW, KEITH E (DO)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:E
Last Name:SNOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1613
Mailing Address - Country:US
Mailing Address - Phone:419-678-5243
Mailing Address - Fax:419-678-5240
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828
Practice Address - Country:US
Practice Address - Phone:419-678-5243
Practice Address - Fax:419-586-1257
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6954207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2090302Medicaid
OH2090302Medicaid
OHSN7319211Medicare ID - Type UnspecifiedMEDICARE
OHBS6021404OtherDEA