Provider Demographics
NPI:1811999659
Name:SNEDEN, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:SNEDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9123
Mailing Address - Country:US
Mailing Address - Phone:605-884-2420
Mailing Address - Fax:605-884-2425
Practice Address - Street 1:917 29TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9123
Practice Address - Country:US
Practice Address - Phone:605-884-2420
Practice Address - Fax:605-884-2425
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A021OtherTRICARE
SD6003042Medicaid
SDG28584Medicare UPIN
SDS5008Medicare PIN
SD6003042Medicaid