Provider Demographics
NPI:1124214820
Name:ZIMA, GRETCHEN G (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:G
Last Name:ZIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653-1 WEST 8TH STREET
Mailing Address - Street 2:BOX L-16
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-244-3050
Mailing Address - Fax:904-244-3028
Practice Address - Street 1:1155 E 21ST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-2401
Practice Address - Country:US
Practice Address - Phone:904-383-1040
Practice Address - Fax:904-350-9651
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88767208000000X
MS23018208000000X
PAMD419893207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01277278Medicaid
LA2409701Medicaid
LA2409701Medicaid