Provider Demographics
NPI:1033205513
Name:ZIMMERMAN, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:200
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1034 NORTH 500 WEST
Practice Address - Street 2:UTAH VALLEY REGIONAL MEDICAL CENTER
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT93-269361-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT342904OtherDESERET MUTUAL
AZ768020Medicaid
UT870545614ZI1OtherEDUCATORS MUTUAL
WY119997800Medicaid
NV002086095Medicaid
UT107007821101OtherIHC
ID806946400Medicaid
UT2090168OtherUNITED HEALTHCARE
UT2614OtherHEALTHY U
UT54112OtherPEHP
UT1502954OtherUMWA
UTPRA03755OtherMOLINA
UTQM0000075886OtherALTIUS
UT050074710Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT342904OtherDESERET MUTUAL
UT107007821101OtherIHC