Provider Demographics
NPI:1588199889
Name:SNELL, JORDAN (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 S MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3423
Mailing Address - Country:US
Mailing Address - Phone:360-767-6305
Mailing Address - Fax:360-767-6320
Practice Address - Street 1:931 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3423
Practice Address - Country:US
Practice Address - Phone:360-767-6300
Practice Address - Fax:360-767-6320
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL60758858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine