Provider Demographics
NPI:1457443905
Name:SNIDLE, WILLIAM F (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:SNIDLE
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 1:1400 US HIGHWAY 61
Mailing Address - Street 2:SUITE 340
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-937-1545
Mailing Address - Fax:636-937-8995
Practice Address - Street 1:1400 US HIGHWAY 61
Practice Address - Street 2:SUITE 340
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-937-1545
Practice Address - Fax:636-937-8995
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4C60174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201482916Medicaid
MO201482916Medicaid
MO002011129Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER