Provider Demographics
NPI:1053536425
Name:SNOW, BRIAN J (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:SNOW
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 1:8080 STATE HIGHWAY 121 STE 320
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2915
Mailing Address - Country:US
Mailing Address - Phone:214-504-7669
Mailing Address - Fax:214-504-7674
Practice Address - Street 1:8080 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 320
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2900
Practice Address - Country:US
Practice Address - Phone:214-504-7669
Practice Address - Fax:214-504-7674
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94218207X00000X
TXN7585207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00929541OtherRAILROAD
TX220287102Medicaid
TX220287101Medicaid
TX220287102Medicaid