Provider Demographics
NPI:1750342739
Name:SNYDERMAN, DAVID ALAN (PAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:SNYDERMAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:211 16TH AVE N
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0009
Mailing Address - Country:US
Mailing Address - Phone:208-467-4431
Mailing Address - Fax:208-467-4684
Practice Address - Street 1:848 S LA CASSIA DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2253
Practice Address - Country:US
Practice Address - Phone:208-344-0086
Practice Address - Fax:208-466-5359
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA286363AM0700X
IDPA-286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1665280OtherCIGNA MEDICARE
ID805539500Medicaid
1665289OtherCIGNA MEDICARE
1665288OtherCIGNA MEDICARE
P94760Medicare UPIN