Provider Demographics
NPI:1306828199
Name:SNYDER, NEIL S (DPM)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16087 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:636-230-3883
Mailing Address - Fax:636-230-3884
Practice Address - Street 1:16087 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2103
Practice Address - Country:US
Practice Address - Phone:636-230-3883
Practice Address - Fax:636-230-3884
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9410M1971213E00000X
MO000660213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4696830001OtherDMERC
MO303056709Medicaid
MO480030905OtherRRMC
990001778OtherGROUP NUMBER
501463806OtherGROUP NUMBER
CK2632OtherGROUP NUMBER
MO000021538Medicare PIN
MO4696830001OtherDMERC