Provider Demographics
NPI:1740294644
Name:SNEAD, HENRY WARREN (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:WARREN
Last Name:SNEAD
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 1:1114 FLAMMANG DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-4306
Mailing Address - Country:US
Mailing Address - Phone:319-233-6991
Mailing Address - Fax:319-291-9122
Practice Address - Street 1:1114 FLAMMANG DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-4306
Practice Address - Country:US
Practice Address - Phone:319-233-6991
Practice Address - Fax:319-291-9122
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66654Medicaid
IAA02527Medicare UPIN
IA66654Medicaid