Provider Demographics
NPI:1154409431
Name:ZIMMERMAN, RAUL L (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:L
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 WOODBRIAR TRL
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-9626
Mailing Address - Country:US
Mailing Address - Phone:386-425-8720
Mailing Address - Fax:386-322-4720
Practice Address - Street 1:3800 WOODBRIAR TRL
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-9626
Practice Address - Country:US
Practice Address - Phone:386-425-8720
Practice Address - Fax:386-322-4720
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64669207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374118400Medicaid
FL374118400Medicaid
FLA92396Medicare UPIN