Provider Demographics
NPI:1922327626
Name:SNYDER, KATHRYN BORDEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BORDEN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:BORDEN
Other - Last Name:GRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 RYAN DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-9687
Mailing Address - Country:US
Mailing Address - Phone:503-399-1262
Mailing Address - Fax:503-371-0777
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD # L340
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-999-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1674712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology