Provider Demographics
NPI:1316900335
Name:ZIMMERMAN, ANTHONY TAYLOR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TAYLOR
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 S MCCARRAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6141
Mailing Address - Country:US
Mailing Address - Phone:775-788-7600
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:6512 S MCCARRAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6141
Practice Address - Country:US
Practice Address - Phone:775-788-7600
Practice Address - Fax:775-788-7600
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11042326OtherCAQH
NV00200993716Medicaid
V39446Medicare ID - Type Unspecified
NVDB776ZMedicare PIN