Provider Demographics
NPI:1295755924
Name:SNOOK, GARY D (MD, PC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:SNOOK
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 AARON DR STE B
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8138
Mailing Address - Country:US
Mailing Address - Phone:435-775-9973
Mailing Address - Fax:435-775-9985
Practice Address - Street 1:2321 N 400 E STE 300
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3440
Practice Address - Country:US
Practice Address - Phone:435-833-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0619207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB149886Medicare PIN
UTB26544Medicare UPIN
TXTXB149886Medicare PIN