Provider Demographics
NPI:1891798831
Name:SNOOK, LEE THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:THOMAS
Last Name:SNOOK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2288 AUBURN BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-1619
Mailing Address - Country:US
Mailing Address - Phone:916-568-8338
Mailing Address - Fax:916-925-3985
Practice Address - Street 1:2288 AUBURN BLVD
Practice Address - Street 2:STE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1619
Practice Address - Country:US
Practice Address - Phone:916-568-8338
Practice Address - Fax:916-925-3985
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG52661208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G526610Medicaid
CA00G526610Medicaid
CA00G526610Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER