Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 354 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 354 | NC |
N | 213ES0131X | Foot Surgery | 354 | NC |
NPI | 1588667687 |
---|---|
Provider Name | Paul P Zimmerman |
First Address | Boone, NC 28607-4738 |
Second Address | Boone, NC 28607-4738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 21/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1326042979 | GROUP NPI (01) | |
890819K | (05) | NC |