Basic Information
| Provider Information | |||||||||
| NPI: | 1467466706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNIDER | ||||||||
| FirstName: | WARREN | ||||||||
| MiddleName: | KIRK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13001 E 17TH PL | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800452570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037246031 | ||||||||
| FaxNumber: | 3037246034 | ||||||||
| Practice Location | |||||||||
| Address1: | 13001 E 17TH PL | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800452570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037246031 | ||||||||
| FaxNumber: | 3037246034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 06/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZH0000X | A64405 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | A64405 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 00A644050 | 05 | CA | MEDICAID |