Provider Demographics
NPI:1457091316
Name:SNYDER, PHILLIP (DO, MAIO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DO, MAIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WESTWOOD DR STE 3100
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7843
Mailing Address - Country:US
Mailing Address - Phone:715-848-4600
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6799
Practice Address - Country:US
Practice Address - Phone:715-848-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program