Provider Demographics
NPI:1003854894
Name:ZIMMERMANN, DAVID R (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:ZIMMERMANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6915 ROBERT DIXON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2268
Mailing Address - Country:US
Mailing Address - Phone:512-892-2196
Mailing Address - Fax:800-819-1655
Practice Address - Street 1:616 W RUSSELL PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX23396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX620003797OtherRAILROAD
TX115667101Medicaid
TX86122AOtherBLUE CROSS BLUE SHIELD
TX115667102Medicaid
TX86044AOtherBLUE CROSS BLUE SHIELD
TX86147AOtherBLUE CROSS BLUE SHIELD
TX86383AOtherBLUE CROSS BLUE SHIELD
TX86147AOtherBLUE CROSS BLUE SHIELD
TX86383AOtherBLUE CROSS BLUE SHIELD