Provider Demographics
NPI:1841272515
Name:SNYDER, SCOTT WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WALTER
Last Name:SNYDER
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 1:350 W COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5892
Mailing Address - Country:US
Mailing Address - Phone:575-624-4646
Mailing Address - Fax:575-625-8498
Practice Address - Street 1:350 W COUNTRY CLUB RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5205
Practice Address - Country:US
Practice Address - Phone:575-624-4646
Practice Address - Fax:575-625-8498
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35719207L00000X, 207V00000X
NMMD2011-0223207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207922238Medicaid
MO39522OtherGROUP HEALTH PLAN
NMNPI & TINOtherBCBS OF NM
MO102614OtherHEALTH LINK
MOA10516OtherMERCY HEALTH PLANS
NM04757033Medicaid
MO116926OtherBLUE CROSS/BLUE SHIELD
MO160051489OtherRAILROAD MEDICARE
MO0706550OtherUNITED HEALTH CARE
MO18184OtherHEALTHCAREUSA
NMNPI & TINOtherBCBS OF NM
NMNMAAA1065Medicare PIN
MO950025593Medicare PIN