Provider Demographics
NPI:1437290285
Name:SNOW, COLLEEN B (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:B
Last Name:SNOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:B
Other - Last Name:HOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:456 N. NEW BALLAS RD.
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-567-6868
Mailing Address - Fax:314-567-0578
Practice Address - Street 1:456 N. NEW BALLAS RD.
Practice Address - Street 2:SUITE 304
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-567-6868
Practice Address - Fax:314-567-0578
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25127208000000X
MO2011013366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics