Provider Demographics
NPI:1588675870
Name:ZIMMERMAN, STANLEY JAY (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JAY
Last Name:ZIMMERMAN
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 1:7707 FANNIN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1926
Mailing Address - Country:US
Mailing Address - Phone:713-797-9999
Mailing Address - Fax:713-795-4651
Practice Address - Street 1:7707 FANNIN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1926
Practice Address - Country:US
Practice Address - Phone:713-797-9999
Practice Address - Fax:713-795-4651
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC5307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275712572OtherGROUP NPI
TX0309064301Medicaid
TXC5307OtherTEXAS MEDICAL LICENSE
TXC23909Medicare UPIN