Provider Demographics
NPI:1801007265
Name:SNOW, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SNOW
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 1:12580 UNIVERSITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5686
Mailing Address - Country:US
Mailing Address - Phone:239-274-0005
Mailing Address - Fax:239-278-4718
Practice Address - Street 1:12580 UNIVERSITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5686
Practice Address - Country:US
Practice Address - Phone:239-274-0005
Practice Address - Fax:239-278-4718
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98236207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE295ZOtherMEDICARE