Provider Demographics
NPI:1891731147
Name:SNYDER, RUSH ALEXANDER JR (MD)
Entity Type:Individual
Prefix:
First Name:RUSH
Middle Name:ALEXANDER
Last Name:SNYDER
Suffix:JR
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 1:6700 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1729
Mailing Address - Country:US
Mailing Address - Phone:806-358-0200
Mailing Address - Fax:806-356-5596
Practice Address - Street 1:6700 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1729
Practice Address - Country:US
Practice Address - Phone:806-358-0200
Practice Address - Fax:806-356-5596
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE77392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D4732Medicare ID - Type Unspecified
TXE7739Medicare UPIN