Provider Demographics
NPI:1811978497
Name:SNYDER, TRAVIS G (MD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:G
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10696 S RIVER FRONT PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3525
Mailing Address - Country:US
Mailing Address - Phone:801-563-0333
Mailing Address - Fax:801-563-0335
Practice Address - Street 1:380 N 200 W
Practice Address - Street 2:SUIE 209
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7079
Practice Address - Country:US
Practice Address - Phone:801-298-1300
Practice Address - Fax:801-296-6199
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6259489-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT62594891200001OtherBCBSUT
UT107052995102OtherSELECTHEALTH
UT62594891202001OtherBCBSUT
UT107052995101OtherSELECTHEALTH
ID807530301Medicaid
WY123199500Medicaid
UT948685OtherDMBA
UTP00353464OtherRR MEDICARE
UTP00651562OtherRR MEDICARE
UTD6845Medicaid
ID807530301Medicaid
I39013Medicare UPIN
UT000059629Medicare PIN