Provider Demographics
NPI:1982128708
Name:ZIMMERMAN, OFER (MD)
Entity type:Individual
Prefix:DR
First Name:OFER
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-996-8670
Mailing Address - Fax:866-362-4984
Practice Address - Street 1:620 S TAYLOR AVE
Practice Address - Street 2:DIV IM ALLERGY AND IMMUNOLOGY, STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1035
Practice Address - Country:US
Practice Address - Phone:314-996-8670
Practice Address - Fax:866-362-4984
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022024180207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200064232Medicaid