Provider Demographics
NPI:1265405906
Name:ZIMMER, PAUL VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VICTOR
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6602
Mailing Address - Country:US
Mailing Address - Phone:907-481-5000
Mailing Address - Fax:907-481-5030
Practice Address - Street 1:1911 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6602
Practice Address - Country:US
Practice Address - Phone:907-481-5000
Practice Address - Fax:907-481-5030
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1749Medicaid
AK920088665OtherCLINIC TAXPAYER NUMBER
AK920088665OtherCLINIC TAXPAYER NUMBER
AKMD1749Medicaid