Provider Demographics
NPI:1457327082
Name:ZIMMER, WILLIAM DEAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8020 CONSTITUTION PLACE NE
Mailing Address - Street 2:#202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-998-3096
Mailing Address - Fax:505-998-3100
Practice Address - Street 1:8020 CONSTITUTION PLACE NE
Practice Address - Street 2:#101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-998-1317
Practice Address - Fax:505-998-1308
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM882862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5868Medicaid
AZ456732Medicaid
ELCAM011Medicare ID - Type Unspecified
E05293Medicare UPIN