Provider Demographics
NPI:1932107950
Name:ZIMMERMAN, CLARK B IV (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:B
Last Name:ZIMMERMAN
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:19964 E HILLTOP ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7399
Mailing Address - Country:US
Mailing Address - Phone:303-841-2212
Mailing Address - Fax:303-841-4716
Practice Address - Street 1:19964 E HILLTOP ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7399
Practice Address - Country:US
Practice Address - Phone:303-841-2212
Practice Address - Fax:303-841-4716
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO34444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG77461Medicare UPIN