Provider Demographics
NPI:1104932839
Name:SNOW, RUSSELL TURNER (DO)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:TURNER
Last Name:SNOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:119 WEST LOGAN STREET
Mailing Address - Street 2:STE A
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605
Mailing Address - Country:US
Mailing Address - Phone:208-454-2050
Mailing Address - Fax:208-454-3554
Practice Address - Street 1:119 WEST LOGAN STREET
Practice Address - Street 2:STE A
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605
Practice Address - Country:US
Practice Address - Phone:208-454-2050
Practice Address - Fax:208-454-3554
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID0110207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002697800Medicaid
ID002697800Medicaid
B48465Medicare UPIN