Provider Demographics
NPI:1437304763
Name:SNYDER, TED H (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:H
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 COCHRANE CIR.
Mailing Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-359-0983
Mailing Address - Fax:
Practice Address - Street 1:1605 COCHRANE CIR.
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-359-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1085001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant