Provider Demographics
NPI:1720023369
Name:SNARR, JACK WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:WALTER
Last Name:SNARR
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 1:1303 SW FIRST AMERICAN PL
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-4059
Mailing Address - Country:US
Mailing Address - Phone:785-234-2306
Mailing Address - Fax:785-234-2550
Practice Address - Street 1:1303 SW FIRST AMERICAN PL
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4059
Practice Address - Country:US
Practice Address - Phone:785-234-2306
Practice Address - Fax:785-234-2550
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-173622085R0202X
NE191222085R0202X
MO20030045982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS052468OtherBC/BS PREMIER BLUE
KS100116370EMedicaid
KS052468Medicare ID - Type Unspecified
KS100116370EMedicaid