Provider Demographics
NPI:1518064625
Name:SNOW, JEFFREY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LOUIS
Last Name:SNOW
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 1:5530 MUNFORD RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2638
Mailing Address - Country:US
Mailing Address - Phone:919-782-9554
Mailing Address - Fax:919-782-9130
Practice Address - Street 1:5530 MUNFORD RD
Practice Address - Street 2:SUITE 119
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2638
Practice Address - Country:US
Practice Address - Phone:919-782-9554
Practice Address - Fax:919-782-9130
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC333102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC78348OtherNC BLUE CROSS BLUE SHILED
NC8978348Medicaid
NC78348OtherNC BLUE CROSS BLUE SHILED
F36043Medicare UPIN