Provider Demographics
NPI:1376545152
Name:SNOWDEN, ROBERT TODD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
Last Name:SNOWDEN
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:PO BOX 41113
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1113
Mailing Address - Country:US
Mailing Address - Phone:904-202-5111
Mailing Address - Fax:904-268-5457
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD STE 401
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5473
Practice Address - Country:US
Practice Address - Phone:904-268-5366
Practice Address - Fax:904-268-5457
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81538207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0046297-00Medicaid
FLP00997636OtherRAILROAD MEDICARE
G49115Medicare UPIN
FL57972YMedicare PIN
FL0046297-00Medicaid