Provider Demographics
NPI:1447205596
Name:ZIMMER, GREGG L (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:L
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 TRANSIT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:E. AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051
Mailing Address - Country:US
Mailing Address - Phone:716-691-3500
Mailing Address - Fax:716-691-3548
Practice Address - Street 1:6041 TRANSIT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:E. AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051
Practice Address - Country:US
Practice Address - Phone:716-691-3500
Practice Address - Fax:716-691-3548
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1955531207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1006228OtherIHA
000523259004OtherBC
000523259004OtherBC
F78334Medicare UPIN