Provider Demographics
NPI:1417989120
Name:SNOW, DAN G (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:G
Last Name:SNOW
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 17892
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1033
Mailing Address - Country:US
Mailing Address - Phone:775-853-7669
Mailing Address - Fax:855-313-0186
Practice Address - Street 1:14039 CRESTED MOSS CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-6102
Practice Address - Country:US
Practice Address - Phone:775-853-7669
Practice Address - Fax:855-313-0186
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV14778207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA010OtherCHAMPUS
NC2076260Medicare PIN
HIG63302Medicare UPIN
HI100334Medicare ID - Type Unspecified