Provider Demographics
NPI:1225461924
Name:NICHOLAS R SNAVELY MD
Entity Type:Organization
Organization Name:NICHOLAS R SNAVELY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER OF EIN
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SNAVELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-767-7546
Mailing Address - Street 1:10815 RR 2222 BLDG 3A STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1159
Mailing Address - Country:US
Mailing Address - Phone:512-767-7546
Mailing Address - Fax:512-767-7545
Practice Address - Street 1:10815 RR 2222 BLDG 3A STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1159
Practice Address - Country:US
Practice Address - Phone:512-767-7546
Practice Address - Fax:512-767-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207N00000X, 207ND0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty