Provider Demographics
NPI:1790778587
Name:SNYDER, MARK DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DEAN
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1035 KEPLER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8320
Mailing Address - Country:US
Mailing Address - Phone:920-490-9046
Mailing Address - Fax:573-248-5196
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:877-229-0273
Practice Address - Fax:920-288-4863
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT66415207L00000X
KS04-22743207L00000X
MO2006001821207L00000X, 207LP2900X
WI51782207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100122940BMedicaid
MO208986505Medicaid
WI35345000Medicaid