Provider Demographics
NPI:1588652606
Name:SNYDER, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SNYDER
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 1:4244 ROSE ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8572
Mailing Address - Country:US
Mailing Address - Phone:707-853-9584
Mailing Address - Fax:530-257-1858
Practice Address - Street 1:4244 ROSE ARBOR WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8572
Practice Address - Country:US
Practice Address - Phone:707-853-9584
Practice Address - Fax:916-239-3611
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A229220Medicare PIN
CAA23307Medicare UPIN
CA00A229222Medicare PIN
CA00A229221Medicare PIN