Basic Information
| Provider Information | |||||||||
| NPI: | 1023341443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNODGRESS | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805505989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706865646 | ||||||||
| FaxNumber: | 9706865118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805505989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706865646 | ||||||||
| FaxNumber: | 9706865118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2009 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4960 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R3756 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0064612 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.