Provider Demographics
NPI:1558417659
Name:SNOOK, RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:SNOOK
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 1:10455 PARK MEADOWS DRIVE
Mailing Address - Street 2:BUILDING 1 UNIT 1
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5414
Mailing Address - Country:US
Mailing Address - Phone:303-708-0246
Mailing Address - Fax:303-708-0247
Practice Address - Street 1:10455 PARK MEADOWS DRIVE
Practice Address - Street 2:BUILDING 1 SUITE 1
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5414
Practice Address - Country:US
Practice Address - Phone:303-708-0246
Practice Address - Fax:303-708-0247
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
525818Medicare ID - Type Unspecified
COCO400033Medicare PIN
COF64365Medicare UPIN