Provider Demographics
NPI:1568434009
Name:MCBRIDE, WAYNE ZIMMER (DO)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ZIMMER
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WINDSONG WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8350
Mailing Address - Country:US
Mailing Address - Phone:309-585-2485
Mailing Address - Fax:
Practice Address - Street 1:6 WINDSONG WAY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8350
Practice Address - Country:US
Practice Address - Phone:309-585-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-129395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine