Provider Demographics
NPI:1841224730
Name:SNYDER, ALAN JAY (DPM)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JAY
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 HILLHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2711
Mailing Address - Country:US
Mailing Address - Phone:323-666-5585
Mailing Address - Fax:323-666-9784
Practice Address - Street 1:1909 HILLHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2711
Practice Address - Country:US
Practice Address - Phone:323-666-5585
Practice Address - Fax:323-666-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2497213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95 3778467OtherANTHEM BLUE CROSS
CA0738670001Medicare NSC
CA95 3778467OtherANTHEM BLUE CROSS