Provider Demographics
NPI:1912985532
Name:SNYDER, THOMAS JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4626 PROGRESS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3485
Mailing Address - Country:US
Mailing Address - Phone:563-386-0850
Mailing Address - Fax:563-386-0847
Practice Address - Street 1:4626 PROGRESS DR
Practice Address - Street 2:SUITE A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3485
Practice Address - Country:US
Practice Address - Phone:563-386-0850
Practice Address - Fax:563-386-0847
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA1772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1912985532Medicaid
IA0202622Medicaid
IA29517Medicare PIN
A02161Medicare UPIN
IA719260369Medicare PIN