Provider Demographics
NPI:1114017548
Name:ROBERT W SNARE MD PA
Entity type:Organization
Organization Name:ROBERT W SNARE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILFORD
Authorized Official - Last Name:SNARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-638-4233
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428
Mailing Address - Country:US
Mailing Address - Phone:850-638-4233
Mailing Address - Fax:
Practice Address - Street 1:1187 MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428
Practice Address - Country:US
Practice Address - Phone:850-638-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty