Provider Demographics
NPI:1588943708
Name:ZIMMER, JEFFERY DALE (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DALE
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:713 GOLF VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9643
Mailing Address - Country:US
Mailing Address - Phone:541-770-1225
Mailing Address - Fax:541-770-1245
Practice Address - Street 1:713 GOLF VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9643
Practice Address - Country:US
Practice Address - Phone:541-770-1225
Practice Address - Fax:541-770-1245
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135.000733213E00000X
ORDP167643213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery