Provider Demographics
NPI:1578172342
Name:ZIMMER, MARK SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SCOTT
Last Name:ZIMMER
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 1:4301 W MARKHAM ST # 515
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:817-975-6610
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 515
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-603-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2024-04-03
Deactivation Date:2024-03-25
Deactivation Code:
Reactivation Date:2024-04-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program