Provider Demographics
NPI:1326042979
Name:BOONE PODIATRY PA
Entity Type:Organization
Organization Name:BOONE PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:828-265-3668
Mailing Address - Street 1:610 STATE FARM RD
Mailing Address - Street 2:STE C
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4738
Mailing Address - Country:US
Mailing Address - Phone:828-265-3668
Mailing Address - Fax:
Practice Address - Street 1:610 STATE FARM RD
Practice Address - Street 2:STE C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4738
Practice Address - Country:US
Practice Address - Phone:828-265-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC354213EP1101X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0819KOtherBCBS
NC890819KMedicaid
NC0819KOtherBCBS
NC0696210001Medicare NSC