Provider Demographics
NPI:1750378311
Name:SNYDER, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746649
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6649
Mailing Address - Country:US
Mailing Address - Phone:904-376-4400
Mailing Address - Fax:904-391-5595
Practice Address - Street 1:1370 13TH AVE S STE 215
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3206
Practice Address - Country:US
Practice Address - Phone:904-249-1041
Practice Address - Fax:904-249-9764
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME557942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0529818-00Medicaid
FL11860WMedicare PIN
FL0529818-00Medicaid
FLC65264Medicare UPIN
FL052981800Medicaid
FL11860WMedicare PIN
FL0529818-00Medicaid