Provider Demographics
NPI:1740461425
Name:RODNEY W SNYDER, MD PLLC
Entity type:Organization
Organization Name:RODNEY W SNYDER, MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-223-0515
Mailing Address - Street 1:PO BOX 1439
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-1439
Mailing Address - Country:US
Mailing Address - Phone:253-223-0515
Mailing Address - Fax:253-927-5472
Practice Address - Street 1:202 N DIVISION ST STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-223-0515
Practice Address - Fax:253-927-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122534Medicaid
WAG8803044Medicare PIN