Provider Demographics
NPI:1275281966
Name:ZELLMER, ERICH JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ERICH
Middle Name:JAMES
Last Name:ZELLMER
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:ELECTRONIC ATTACK SQUADRON 132
Mailing Address - Street 2:3760 N CHARLES PORTER AVE
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:98278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3760 N CHARLES PORTER AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-0001
Practice Address - Country:US
Practice Address - Phone:813-395-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023029169208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice