Provider Demographics
NPI:1306845367
Name:ZIMMERMAN, BROOKS B (DO)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:B
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3920
Mailing Address - Country:US
Mailing Address - Phone:580-223-5311
Mailing Address - Fax:580-223-2397
Practice Address - Street 1:1020 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3920
Practice Address - Country:US
Practice Address - Phone:580-223-5311
Practice Address - Fax:580-223-2397
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100091450AMedicaid
OK100091450AMedicaid
OKP00613504Medicare PIN