Provider Demographics
NPI:1235181256
Name:SNIDER, BRUCE BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BENJAMIN
Last Name:SNIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-764-6262
Mailing Address - Fax:913-764-6870
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-764-6262
Practice Address - Fax:913-764-6870
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23022207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2050247602Medicaid
KSBS2040727OtherDEA
KSE50572Medicare UPIN
KS2050247602Medicaid