Provider Demographics
NPI:1437145125
Name:SNELL, DAVID JOTHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOTHAM
Last Name:SNELL
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 701
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92678-0701
Mailing Address - Country:US
Mailing Address - Phone:949-589-9595
Mailing Address - Fax:
Practice Address - Street 1:475-750 RICE CANYON ROAD
Practice Address - Street 2:MEDICAL ADMINISTRATION
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96127
Practice Address - Country:US
Practice Address - Phone:530-251-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG397542083A0100X
CAG-39754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine