Provider Demographics
NPI:1386876761
Name:SNYDER, ETHAN LOWELL (PA-C)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:LOWELL
Last Name:SNYDER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6360 SOUTH 3000 EAST
Mailing Address - Street 2:#300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6926
Mailing Address - Country:US
Mailing Address - Phone:801-944-3144
Mailing Address - Fax:801-944-3186
Practice Address - Street 1:368 E RIVERSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6896
Practice Address - Country:US
Practice Address - Phone:435-215-1611
Practice Address - Fax:435-673-1182
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2022-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT7426326-1206363AM0700X, 363A00000X
UT7426326-8906363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical