Provider Demographics
NPI:1326232075
Name:DR ZANE WESLEY ZIMMERMAN LLC
Entity Type:Organization
Organization Name:DR ZANE WESLEY ZIMMERMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-879-5493
Mailing Address - Street 1:4778 ERIE AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-9605
Mailing Address - Country:US
Mailing Address - Phone:330-879-5493
Mailing Address - Fax:330-879-5935
Practice Address - Street 1:4778 ERIE AVE SW
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-9605
Practice Address - Country:US
Practice Address - Phone:330-879-5493
Practice Address - Fax:330-879-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008053Z207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9336041Medicare PIN