Provider Demographics
NPI:1770763930
Name:ORRENZO SNYDER MD MEDICAL CORPORATION
Entity type:Organization
Organization Name:ORRENZO SNYDER MD MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORRENZO
Authorized Official - Middle Name:B
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-935-1702
Mailing Address - Street 1:263 PEARSON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3333
Mailing Address - Country:US
Mailing Address - Phone:559-772-4301
Mailing Address - Fax:559-772-4302
Practice Address - Street 1:263 PEARSON DR STE 102
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3333
Practice Address - Country:US
Practice Address - Phone:559-772-4301
Practice Address - Fax:559-772-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00324940OtherRAILROAD MEDICARE
AZ987349Medicaid
NV100507194Medicaid
P00324940OtherRAILROAD MEDICARE
V101814Medicare PIN