Provider Demographics
NPI:1003814021
Name:SNOW, JEFFERY M (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:M
Last Name:SNOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:427 S BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2509
Mailing Address - Country:US
Mailing Address - Phone:509-456-0107
Mailing Address - Fax:509-747-2635
Practice Address - Street 1:427 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2509
Practice Address - Country:US
Practice Address - Phone:509-456-0107
Practice Address - Fax:509-747-2635
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014119207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1681907Medicaid
WAWA0690OtherNORTHWEST BENEFIT NETWORK
WAKE03366OtherASURIS(REGENCE NW HEALTH)
ID000010003061OtherASURIS(REGENCE BS OF ID)
WA532OtherGROUP HEALTH
WA60664OtherLABOR AND INDUSTRIES
WAA011OtherTRICARE
IDKA428OtherBLUE CROSS OF ID
IDKA428OtherBLUE CROSS OF ID