Provider Demographics
NPI:1275528739
Name:SNELL, JOHN L III (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:SNELL
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5337
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:SUITE 208
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-6952
Practice Address - Fax:502-899-9689
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0413542OtherCIGNA/NORTON
096990OtherSIHO/NORTON
KY64079122Medicaid
KYP00626228OtherRAILROAD-NCMA
0000557851OtherANTHEM/NORTON
KY64079122Medicaid
KYP00143907Medicare PIN
KY0639004Medicare PIN
096990OtherSIHO/NORTON