Provider Demographics
NPI:1629155130
Name:SNYDER, WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
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 1:990 E STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-9199
Mailing Address - Country:US
Mailing Address - Phone:317-736-8474
Mailing Address - Fax:317-736-6040
Practice Address - Street 1:990 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-9199
Practice Address - Country:US
Practice Address - Phone:317-736-8474
Practice Address - Fax:317-736-6040
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194080Medicaid
080158793Medicare PIN
IN151560PPPMedicare PIN
INE29040Medicare UPIN
IN100194080Medicaid