Provider Demographics
NPI:1194777623
Name:SNYDER, JEFFREY TODD (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TODD
Last Name:SNYDER
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11111 S 84TH ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4122
Practice Address - Country:US
Practice Address - Phone:402-593-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22538207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35465OtherWELLMARK BCBS
NE100251217-00Medicaid
NE100249951-00Medicaid
NE100251147-00Medicaid
IA4298455Medicaid
IA0298455Medicaid
IA5298455Medicaid
NE01267OtherBCBS NE
NE100249951-00Medicaid
IAP00082836Medicare PIN
NEP00104238Medicare PIN
IA35465OtherWELLMARK BCBS
IA5298455Medicaid