Provider Demographics
NPI:1609861020
Name:ZIMMERMAN, GRETCHEN MARY (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MARY
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 2180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2341
Mailing Address - Country:US
Mailing Address - Phone:713-797-9500
Mailing Address - Fax:713-797-9511
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 2180
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2341
Practice Address - Country:US
Practice Address - Phone:713-797-9500
Practice Address - Fax:713-797-9511
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-10-12
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXG2253208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097085702Medicaid
TX8F24531Medicare PIN
TXC23908Medicare UPIN