Provider Demographics
NPI:1962470302
Name:SNYDER, JAMES R (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:11901 LOFTON AVE S
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-8408
Mailing Address - Country:US
Mailing Address - Phone:651-438-2899
Mailing Address - Fax:
Practice Address - Street 1:1655 BEAM AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1163
Practice Address - Country:US
Practice Address - Phone:651-232-7831
Practice Address - Fax:651-232-7826
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN8918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU35887Medicare UPIN