Provider Demographics
NPI:1871547869
Name:SNYDER, JEANNE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1621 TONGASS AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6013
Mailing Address - Country:US
Mailing Address - Phone:907-225-6699
Mailing Address - Fax:907-247-1199
Practice Address - Street 1:1621 TONGASS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6013
Practice Address - Country:US
Practice Address - Phone:907-225-6699
Practice Address - Fax:907-247-1199
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKAK3831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0069Medicaid
AKMD0069Medicaid