Basic Information
| Provider Information | |||||||||
| NPI: | 1093907404 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JACK L SNITZER, D.O., P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 S DIVISION ST STE A | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218047291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105728848 | ||||||||
| FaxNumber: | 4105726890 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 S DIVISION ST STE A | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218047291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105728848 | ||||||||
| FaxNumber: | 4105726890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 08/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | SNITZER | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4105728848 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | H44532 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.