Provider Demographics
NPI:1760696918
Name:SNODGRASS, BRETT T (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:T
Last Name:SNODGRASS
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 1:100A KENRICK PLAZA
Mailing Address - Street 2:JULIE THOMAS
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4416
Mailing Address - Country:US
Mailing Address - Phone:314-968-0076
Mailing Address - Fax:314-968-6883
Practice Address - Street 1:1 SOUTHTOWNE DR.
Practice Address - Street 2:GREAT MINES HEALTH CENTER
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664
Practice Address - Country:US
Practice Address - Phone:573-438-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015989208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice