Provider Demographics
NPI:1104817683
Name:SNIPES, JAMES DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:SNIPES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TARTAN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-8002
Mailing Address - Country:US
Mailing Address - Phone:319-929-0741
Mailing Address - Fax:
Practice Address - Street 1:104 BROADWAY PL
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1100
Practice Address - Country:US
Practice Address - Phone:319-462-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0110346Medicaid
IA0110346Medicaid
IAH96569Medicare UPIN