Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | G054173 | CA |
NPI | 1871565408 |
---|---|
Provider Name | Dr. Terry Jay Zimmerman |
First Address | Folsom, CA 95630-3892 |
Second Address | Folsom, CA 95630-3892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E90086 | (02) | CA |