Provider Demographics
NPI:1861483539
Name:ZIMMERMAN, CLINTON BALLARD JR (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:BALLARD
Last Name:ZIMMERMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:579 GREENWAY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4809
Mailing Address - Country:US
Mailing Address - Phone:828-262-0100
Mailing Address - Fax:828-264-7592
Practice Address - Street 1:579 GREENWAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4809
Practice Address - Country:US
Practice Address - Phone:828-262-0100
Practice Address - Fax:828-264-7592
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC34214208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC62308-NOCDOtherCIGNA
NC8991EOtherBLUE CROSS/BLUE SHIELD
NC8991EOtherFEDERAL EMPLOYEES
NC12-71030OtherUNITED HEALTH CARE
NC72758OtherMEDCOST
NC898991EMedicaid
NC8991EOtherNC HEALTH CHOICE
NC8991EOtherSTATE HEALTH PLAN
NC62308-NOCDOtherCIGNA