Provider Demographics
NPI:1801867122
Name:ZIMMERMAN, STEPHEN H (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3117
Mailing Address - Country:US
Mailing Address - Phone:870-735-6500
Mailing Address - Fax:870-735-4442
Practice Address - Street 1:401 GRAHAM ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3117
Practice Address - Country:US
Practice Address - Phone:870-735-6500
Practice Address - Fax:870-735-4442
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120213E00000X
TN365213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118596717Medicaid
TN480010758OtherMEDICARE ID TYPE UNSPECIFIED
AR480027256OtherMEDICARE ID TYPE UNSPECIFIED
AR480027256OtherMEDICARE ID TYPE UNSPECIFIED
TN3351813Medicare PIN
U01895Medicare UPIN