Provider Demographics
NPI:1609985233
Name:SNOW, TARA M (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:SNOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2594 TRAILRIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3186
Mailing Address - Country:US
Mailing Address - Phone:303-449-7740
Mailing Address - Fax:303-604-5393
Practice Address - Street 1:4747 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1131
Practice Address - Country:US
Practice Address - Phone:303-415-7610
Practice Address - Fax:303-415-7618
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO42562208M00000X
CAA99406208M00000X
CODR.0042562207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27270246Medicaid
CO27270246Medicaid
I25220Medicare UPIN
CAWA99406AMedicare PIN