Provider Demographics
NPI:1548331226
Name:SNIDER, BRUCE ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:SNIDER
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 1:510 GRAVES AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-3309
Mailing Address - Country:US
Mailing Address - Phone:859-341-5014
Mailing Address - Fax:859-341-5136
Practice Address - Street 1:510 GRAVES AVE STE 210
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-3309
Practice Address - Country:US
Practice Address - Phone:859-341-5014
Practice Address - Fax:859-341-5136
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168352084P0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64168354Medicaid
KYC71581Medicare UPIN
KYK036011Medicare PIN
KY1208601Medicare PIN