Provider Demographics
NPI:1669640538
Name:WILLIAM J. SNIDER, M.D. A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:WILLIAM J. SNIDER, M.D. A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-2663
Mailing Address - Street 1:2160 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2530
Mailing Address - Country:US
Mailing Address - Phone:530-244-2663
Mailing Address - Fax:530-244-4309
Practice Address - Street 1:2160 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2530
Practice Address - Country:US
Practice Address - Phone:530-244-2663
Practice Address - Fax:530-244-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC357690207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C357690Medicaid
CA00C357690Medicaid
CAZZZ07671ZMedicare PIN