Provider Demographics
NPI:1821202482
Name:GRETCHEN M ZIMMERMAN, MD, PA
Entity Type:Organization
Organization Name:GRETCHEN M ZIMMERMAN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-797-9500
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-797-9500
Mailing Address - Fax:713-797-9511
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2307
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-797-9500
Practice Address - Fax:713-797-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2253208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0970857-02Medicaid
TXC23908Medicare UPIN
TX0A6274Medicare PIN