Provider Demographics
NPI:1255511309
Name:SNYDER, JEQUITA DAWN (DO)
Entity type:Individual
Prefix:
First Name:JEQUITA
Middle Name:DAWN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:620-231-1960
Mailing Address - Fax:
Practice Address - Street 1:106 NW VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1818
Practice Address - Country:US
Practice Address - Phone:918-238-3074
Practice Address - Fax:918-238-3076
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200133230AMedicaid
OK200133230AMedicaid