Provider Demographics
NPI:1609107309
Name:SNYDER, MICHAEL GENE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GENE
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18225 LEGION RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH SETTLEMENT
Mailing Address - State:LA
Mailing Address - Zip Code:70733-2215
Mailing Address - Country:US
Mailing Address - Phone:225-279-0284
Mailing Address - Fax:225-698-9619
Practice Address - Street 1:18225 LEGION RD
Practice Address - Street 2:
Practice Address - City:FRENCH SETTLEMENT
Practice Address - State:LA
Practice Address - Zip Code:70733-2215
Practice Address - Country:US
Practice Address - Phone:225-279-0284
Practice Address - Fax:225-698-9619
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA553877171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1529869Medicaid