Provider Demographics
NPI:1649677436
Name:SNYDER, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30466 SGT E I BOOTS THOMAS DR
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-7630
Mailing Address - Country:US
Mailing Address - Phone:251-626-4605
Mailing Address - Fax:251-517-1014
Practice Address - Street 1:30466 SGT E I BOOTS THOMAS DR
Practice Address - Street 2:SUITE 206A
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-7630
Practice Address - Country:US
Practice Address - Phone:251-626-4605
Practice Address - Fax:251-517-1014
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-23
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier