Provider Demographics
NPI:1669428736
Name:SNIHUROWYCH, WALTER M (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:M
Last Name:SNIHUROWYCH
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:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0964
Mailing Address - Country:US
Mailing Address - Phone:435-637-4048
Mailing Address - Fax:435-636-0171
Practice Address - Street 1:250 N FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4203
Practice Address - Country:US
Practice Address - Phone:435-637-4048
Practice Address - Fax:435-636-0171
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163736-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1015125OtherTHE FUNDS
UT000000963Medicare ID - Type Unspecified
UT1015125OtherTHE FUNDS