Provider Demographics
NPI:1952366346
Name:SNIDER, SANDRA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JO
Last Name:SNIDER
Suffix:
Gender:F
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:PO BOX 842120
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-2120
Mailing Address - Country:US
Mailing Address - Phone:417-239-3392
Mailing Address - Fax:
Practice Address - Street 1:525 BRANSON LANDING BLVD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-335-7000
Practice Address - Fax:417-239-3394
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009023917207LP3000X, 207L00000X
IA33273207L00000X
NE19573207L00000X
OK26872207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1967273Medicaid
IAG32624Medicare UPIN
IA1967273Medicaid
NEG32624Medicare UPIN
IA16892Medicare ID - Type Unspecified