Provider Demographics
NPI:1780681528
Name:SNYDER, STANLEY O JR (MD, RVT)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:O
Last Name:SNYDER
Suffix:JR
Gender:M
Credentials:MD, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 24TH AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1514
Mailing Address - Country:US
Mailing Address - Phone:615-292-5722
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 525
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-385-1547
Practice Address - Fax:615-297-9161
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26740208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3091269Medicare PIN
TN30912671Medicare PIN
TNB06289Medicare UPIN