Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 23396 | TX |
Y | 103TC0700X | Clinical Psychologist | 23396 | TX |
NPI | 1003854894 |
---|---|
Provider Name | Dr. David R Zimmermann |
First Address | Austin, TX 78749-2268 |
Second Address | San Antonio, TX 78212-3658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 17/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115667101 | (05) | TX |
115667102 | (05) | TX |
620003797 | RAILROAD (01) | TX |
86044A | BLUE CROSS BLUE SHIELD (01) | TX |
86122A | BLUE CROSS BLUE SHIELD (01) | TX |
86147A | BLUE CROSS BLUE SHIELD (01) | TX |
86383A | BLUE CROSS BLUE SHIELD (01) | TX |