Provider Demographics
NPI:1366411803
Name:SNODGRASS, WARREN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:THOMAS
Last Name:SNODGRASS
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 1:5680 FRISCO SQUARE BLVD STE 2300
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3321
Mailing Address - Country:US
Mailing Address - Phone:214-618-4405
Mailing Address - Fax:214-618-5506
Practice Address - Street 1:5680 FRISCO SQUARE BLVD STE 2300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:214-618-4405
Practice Address - Fax:214-618-5506
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF71832088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136170106Medicaid
B26543Medicare UPIN
85512KMedicare ID - Type Unspecified