Provider Demographics
NPI:1801942131
Name:SNIDER, DAVID W (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:SNIDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 E RYAN DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7236
Mailing Address - Country:US
Mailing Address - Phone:989-631-7438
Mailing Address - Fax:
Practice Address - Street 1:4911 HEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-1930
Practice Address - Country:US
Practice Address - Phone:989-631-8200
Practice Address - Fax:989-631-5901
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS001126213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT34102Medicare UPIN
MI0E68062Medicare ID - Type Unspecified