Provider Demographics
NPI:1245229178
Name:SNELLER, GARY RICHARD II (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RICHARD
Last Name:SNELLER
Suffix:II
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1909 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5599
Mailing Address - Country:US
Mailing Address - Phone:077-458-8513
Mailing Address - Fax:307-742-0942
Practice Address - Street 1:1909 VISTA DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5599
Practice Address - Country:US
Practice Address - Phone:307-745-8851
Practice Address - Fax:307-742-0961
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2024-01-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008551500Medicaid
37804OtherBCBS FL