Provider Demographics
NPI:1386646669
Name:ZIMMERMAN, EDWARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-2307
Mailing Address - Country:US
Mailing Address - Phone:307-347-8885
Mailing Address - Fax:307-347-2428
Practice Address - Street 1:316 N 10TH ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-2307
Practice Address - Country:US
Practice Address - Phone:307-347-8885
Practice Address - Fax:307-347-2428
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8034A207P00000X, 261QM0801X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100377060BMedicaid
WYW22056Medicare PIN
KS100377060BMedicaid
WYW22055Medicare PIN