Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME64669 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME64669 | FL |
NPI | 1154409431 |
---|---|
Provider Name | Dr. Raul L Zimmerman |
First Address | Port Orange, FL 32129-9626 |
Second Address | Port Orange, FL 32129-9626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 13/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
374118400 | (05) | FL |
A92396 | (02) | FL |