Provider Demographics
NPI:1326496019
Name:ZIMBELMAN, NOAH STEPHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:STEPHAN
Last Name:ZIMBELMAN
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 1:2036 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2508
Mailing Address - Country:US
Mailing Address - Phone:916-501-2139
Mailing Address - Fax:
Practice Address - Street 1:50 E DUNLAP DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1618
Practice Address - Country:US
Practice Address - Phone:719-547-5138
Practice Address - Fax:719-547-4374
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0006189207Q00000X
CODR.0062719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000158262Medicaid