Provider Demographics
NPI:1902454358
Name:SNIDER, MICHAEL TRAVIS (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TRAVIS
Last Name:SNIDER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:830 US HIGHWAY 98 APT 832
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5812
Mailing Address - Country:US
Mailing Address - Phone:850-582-1507
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5599
Practice Address - Fax:228-523-4526
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant