Provider Demographics
NPI:1407874068
Name:ZIMMERMAN, CHRISTIAN G (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:G
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6140 CURTISIAN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8880
Mailing Address - Country:US
Mailing Address - Phone:208-367-3500
Mailing Address - Fax:208-367-2968
Practice Address - Street 1:6140 CURTISIAN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8880
Practice Address - Country:US
Practice Address - Phone:208-367-3500
Practice Address - Fax:208-367-2968
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6164207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002733000Medicaid
ID8J711OtherBC OF IDAHO GROUP
OR057633OtherOMAP
185367100OtherUS DEPARTMENT OF LABOR
WA58097OtherWA DEPARTMENT OF LABOR
ID807730000Medicaid
WA0182710OtherWA DOL
ID72488OtherBLUE CROSS OF IDAHO
ID000010004671OtherREGENCE BLUESHIELD
140002620Medicare PIN
OR057633OtherOMAP
WA58097OtherWA DEPARTMENT OF LABOR