Provider Demographics
NPI:1972691582
Name:ZIMMERMAN, MARC HERBERT (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:HERBERT
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1840 MESQUITE AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5771
Mailing Address - Country:US
Mailing Address - Phone:928-453-2663
Mailing Address - Fax:928-453-1452
Practice Address - Street 1:1840 MESQUITE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5771
Practice Address - Country:US
Practice Address - Phone:928-453-2663
Practice Address - Fax:928-453-1452
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ14797207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0223190001Medicare NSC
AZD37892Medicare UPIN
AZZ83626Medicare PIN