Provider Demographics
NPI:1215944921
Name:ZIMMERMAN, JAMES RICHARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICHARD
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:BAGGS
Mailing Address - State:WY
Mailing Address - Zip Code:82321-0037
Mailing Address - Country:US
Mailing Address - Phone:307-383-2008
Mailing Address - Fax:307-383-2009
Practice Address - Street 1:15 LASH ST
Practice Address - Street 2:
Practice Address - City:BAGGS
Practice Address - State:WY
Practice Address - Zip Code:82321-5005
Practice Address - Country:US
Practice Address - Phone:307-383-2008
Practice Address - Fax:307-383-2009
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA 780363A00000X
WY152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50275291Medicaid
CO50275291Medicaid