Provider Demographics
NPI:1649210774
Name:SNOWDY, PAUL A (PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:SNOWDY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4973
Mailing Address - Fax:
Practice Address - Street 1:6601 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-6138
Practice Address - Country:US
Practice Address - Phone:515-643-9431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001703363A00000X
TN1220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0100OtherUHC OF THE RIVER VALLEY
IA27099OtherWELLMARK BLUE SHIELD
IAIA0100OtherUHC OF THE RIVER VALLEY
IAP82288Medicare UPIN
IAI18660Medicare PIN