Provider Demographics
NPI:1558680587
Name:SNOW, BRIAN DOXEY (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DOXEY
Last Name:SNOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3525 E LOUISE DR STE 195
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6303
Mailing Address - Country:US
Mailing Address - Phone:208-846-8335
Mailing Address - Fax:208-472-0526
Practice Address - Street 1:4424 E FLAMINGO AVE STE 340
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9306
Practice Address - Country:US
Practice Address - Phone:208-846-8335
Practice Address - Fax:208-846-8336
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012787207RN0300X
VA0102202953208D00000X
390200000X
IDO-1209207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDFS6845171OtherDEA