Provider Demographics
NPI:1013919505
Name:ZIMMERMAN, JEFFRY A (PA)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CAPEWAY RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:ST FRANCIS EMERGENCY DEPARTMENT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-287-7066
Practice Address - Fax:804-673-9531
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001164207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001164OtherBOARD OF MEDICINE
VA018474P20Medicare PIN
VA970000569Medicare PIN
VA003475V01Medicare PIN
VAVAA103032Medicare PIN
S00771Medicare UPIN
VA970000398Medicare PIN