Provider Demographics
NPI:1508859752
Name:SNOOK, DEREK L (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:L
Last Name:SNOOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-713-1779
Mailing Address - Fax:513-854-9921
Practice Address - Street 1:7277 SMITHS MILL RD STE 200
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8195
Practice Address - Country:US
Practice Address - Phone:614-221-6331
Practice Address - Fax:614-221-9042
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35076736207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2419494Medicaid
OH000000349503OtherANTHEM
OH7051439OtherAETNA
OHH70110Medicare UPIN
OH2419494Medicaid