Provider Demographics
NPI:1629187323
Name:SNYDER, EVAN YALE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:YALE
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 GLENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5424
Mailing Address - Country:US
Mailing Address - Phone:858-729-1984
Mailing Address - Fax:858-795-5273
Practice Address - Street 1:402 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6902
Practice Address - Country:US
Practice Address - Phone:619-543-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist