Provider Demographics
NPI:1730196783
Name:SNYDER, HERMAN LISLE JR (DPM)
Entity type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:LISLE
Last Name:SNYDER
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:MR
Other - First Name:LISLE
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:207 W G ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3113
Mailing Address - Country:US
Mailing Address - Phone:423-543-8719
Mailing Address - Fax:423-543-8374
Practice Address - Street 1:207 W G ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3113
Practice Address - Country:US
Practice Address - Phone:423-543-8719
Practice Address - Fax:423-543-8374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN138213E00000X
NC89213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND295Medicaid
TN2006277OtherBCBS
TNTN0101OtherUNITED HEALTH
TND295Medicaid
TN2006277OtherBCBS
TN3350528Medicare PIN