Provider Demographics
NPI:1801099460
Name:SNAVELY, NICHOLAS RICHARD (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RICHARD
Last Name:SNAVELY
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 1:5310 HARVEST HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5827
Mailing Address - Country:US
Mailing Address - Phone:214-420-0672
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:5026 TENNYSON PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3360
Practice Address - Country:US
Practice Address - Phone:972-985-1920
Practice Address - Fax:512-767-7545
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0140207N00000X, 207ND0101X, 207N00000X, 207ND0101X
VA0101242813207ND0101X
ORMD150812207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB138403Medicare PIN
TX289383601Medicaid
1801099460OtherMEDICAID CVFP INC
TXTXB138403Medicare PIN
TXP0140OtherPHYSICIAN PERMIT