Provider Demographics
NPI:1710085642
Name:JEFFREY A SNYDER MD PC
Entity Type:Organization
Organization Name:JEFFREY A SNYDER MD PC
Other - Org Name:GENITOURINARY SURGICAL CONSULTANTS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-239-0309
Mailing Address - Street 1:4500 E 9TH AVE STE 530S
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3924
Mailing Address - Country:US
Mailing Address - Phone:303-320-0200
Mailing Address - Fax:303-320-4111
Practice Address - Street 1:4500 E 9TH AVE STE 530S
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3924
Practice Address - Country:US
Practice Address - Phone:303-320-0200
Practice Address - Fax:303-320-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16854861Medicaid
COCM9808Medicare PIN