Provider Demographics
NPI:1134342538
Name:SNELL FONTUS, MD, LLC
Entity type:Organization
Organization Name:SNELL FONTUS, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-684-4716
Mailing Address - Street 1:PO BOX 10882
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2882
Mailing Address - Country:US
Mailing Address - Phone:541-684-4716
Mailing Address - Fax:541-683-9790
Practice Address - Street 1:1053 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3205
Practice Address - Country:US
Practice Address - Phone:541-684-4716
Practice Address - Fax:541-683-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD202862086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR086108Medicaid
ORF87179Medicare UPIN
OR102326Medicare ID - Type Unspecified