1003814021 NPI number — DR. JEFFERY M. SNOW M.D.

Table of content: DR. JEFFERY M. SNOW M.D. (NPI 1003814021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003814021 NPI number — DR. JEFFERY M. SNOW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNOW
Provider First Name:
JEFFERY
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003814021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 S BERNARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-456-0107
Provider Business Mailing Address Fax Number:
509-747-2635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 S BERNARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-0107
Provider Business Practice Location Address Fax Number:
509-747-2635
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD00014119 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1681907 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: WA0690 . This is a "NORTHWEST BENEFIT NETWORK" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: KE03366 . This is a "ASURIS(REGENCE NW HEALTH)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000010003061 . This is a "ASURIS(REGENCE BS OF ID)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 532 . This is a "GROUP HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 60664 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: A011 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: KA428 . This is a "BLUE CROSS OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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