Provider Demographics
NPI:1255340477
Name:SNYDER, RICHARD JOEL (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOEL
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 FROST ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4205
Mailing Address - Country:US
Mailing Address - Phone:858-292-7527
Mailing Address - Fax:858-292-7804
Practice Address - Street 1:8008 FROST ST
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4205
Practice Address - Country:US
Practice Address - Phone:858-292-7525
Practice Address - Fax:858-292-7804
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47409207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G474090Medicaid
CA00G4740900Medicaid
CA100002788OtherMEDICARE RAILROAD
CA00G474090Medicaid