Provider Demographics
NPI:1295775203
Name:ZIMMERMAN, LANCE CLAIR (DPM)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:CLAIR
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 AVONDALE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1388
Mailing Address - Country:US
Mailing Address - Phone:916-978-7950
Mailing Address - Fax:
Practice Address - Street 1:1870 AVONDALE AVE STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1388
Practice Address - Country:US
Practice Address - Phone:916-978-7950
Practice Address - Fax:916-978-9506
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2435213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E24350Medicare PIN
CA0839820001Medicare NSC