Organization
ORL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANFORD C SNYDERMAN MD (SECRETARY)
(260) 422-2386
Entity
Organization
Contact information
Practice address
800 BROADWAY, STE 207, FORT WAYNE, IN 46802-2149
(260) 422-2386
(260) 422-3985
Mailing address
800 BROADWAY, STE 207, FORT WAYNE, IN 46802-2149
(260) 422-2386
(260) 422-3985
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01016604A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000085958
ANTHEM BCBS
IN
Enumeration date
09/11/2006
Last updated
08/22/2020
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