Provider Demographics
NPI:1336241868
Name:SNOW, JANE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:SNOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1027 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1748
Mailing Address - Country:US
Mailing Address - Phone:510-507-4401
Mailing Address - Fax:510-588-4840
Practice Address - Street 1:1027 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1748
Practice Address - Country:US
Practice Address - Phone:510-507-4401
Practice Address - Fax:510-588-4840
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22573207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA225730Medicaid
CAD37906Medicare UPIN
CAA225730Medicaid