Provider Demographics
NPI:1477597037
Name:SNYDER, RYAN R (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:R
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 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-6066
Mailing Address - Fax:816-792-5130
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-6066
Practice Address - Fax:816-792-5130
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012117207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475000006OtherMEDICARE PTAN
0388010001OtherDMERC
MO1477597037Medicaid
MO475000006OtherMEDICARE PTAN