Provider Demographics
NPI:1093729121
Name:ZIMMERMAN, JAMES JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JEROME
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-366-0225
Mailing Address - Fax:
Practice Address - Street 1:2900 WHIPPLE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2851
Practice Address - Country:US
Practice Address - Phone:650-366-0225
Practice Address - Fax:650-367-6085
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG391102085R0202X, 2085R0204X, 2086S0129X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G391100Medicaid
CAGR0052800Medicaid
CACP2153OtherMEDICARE RAILROAD
CAGR0052800Medicaid
CAAP493AMedicare PIN
CACN756YMedicare PIN
CA00G391100Medicaid
CACP2153OtherMEDICARE RAILROAD
CAZZZ23469ZMedicare PIN
CACN756ZMedicare PIN
CAAP493Medicare PIN