Provider Demographics
NPI:1730294356
Name:SNYDER, JAMIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 BARTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1489
Mailing Address - Country:US
Mailing Address - Phone:909-558-9547
Mailing Address - Fax:909-558-9595
Practice Address - Street 1:1686 BARTON RD STE D
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-1489
Practice Address - Country:US
Practice Address - Phone:909-558-9547
Practice Address - Fax:909-558-9595
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG640252084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE276026Medicare PIN
NE260052021Medicare PIN
NE093285Medicare PIN