Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-151049 | IL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 75795-20 | WI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 7590 | GA |
N | 207YS0123X | Facial Plastic Surgeon | 036-151049 | IL |
N | 207YS0123X | Facial Plastic Surgeon | 036151049 | IL |
Y | 207YS0123X | Facial Plastic Surgeon | 75795-20 | WI |
NPI | 1265815187 |
---|---|
Provider Name | Dr. Zachary Adam Zimmerman |
First Address | Beloit, WI 53511-1842 |
Second Address | Beloit, WI 53511-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2015 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7590 | GEORGIA COMPOSITE MEDICAL BOARD (01) | FL |