Provider Demographics
NPI:1972580199
Name:SNIDER, GARY R (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:SNIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FRANKLIN ST
Mailing Address - Street 2:STE 470
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1128
Mailing Address - Country:US
Mailing Address - Phone:303-860-7900
Mailing Address - Fax:303-839-5367
Practice Address - Street 1:1830 FRANKLIN ST
Practice Address - Street 2:STE 470
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1128
Practice Address - Country:US
Practice Address - Phone:303-860-7900
Practice Address - Fax:303-839-5367
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO27042208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01270420Medicaid
E65902Medicare UPIN
CO01270420Medicaid