Basic Information
| Provider Information | |||||||||
| NPI: | 1033188073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNODGRASS | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 E 14TH ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689013200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024632929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 223 E 14TH ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689013200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024632929 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 27778 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | R8F27 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.