Provider Demographics
NPI:1477678506
Name:ZIMMER, LAURIE EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:EILEEN
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:EILEEN
Other - Last Name:OLNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4501 DIPLOMACY DR
Mailing Address - Street 2:ATTN: FINANCE/PROVIDER ENROLLMENT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5919
Mailing Address - Country:US
Mailing Address - Phone:907-729-3300
Mailing Address - Fax:
Practice Address - Street 1:4320 DIPLOMACY DRIVE
Practice Address - Street 2:SUITE 1191 PRIMARY CARE CLINIC 1 EAST
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-729-3371
Practice Address - Fax:907-729-4140
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD39831Medicaid
AK39831Medicaid
AKMD39831Medicaid
AKG95189Medicare UPIN