Provider Demographics
NPI:1376816264
Name:ZIMMER, JURGEN
Entity Type:Individual
Prefix:
First Name:JURGEN
Middle Name:
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2550
Mailing Address - Country:US
Mailing Address - Phone:843-449-1200
Mailing Address - Fax:843-492-5116
Practice Address - Street 1:5103 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2550
Practice Address - Country:US
Practice Address - Phone:843-449-1200
Practice Address - Fax:843-492-5116
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC49980335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier