Provider Demographics
NPI:1457424046
Name:ZIMMER, STEPHEN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRUCE
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 1:294 N HIGHWAY 16
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8011
Mailing Address - Country:US
Mailing Address - Phone:704-660-4041
Mailing Address - Fax:704-489-2900
Practice Address - Street 1:294 N HIGHWAY 16
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8011
Practice Address - Country:US
Practice Address - Phone:704-660-4041
Practice Address - Fax:704-489-2900
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-00434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080123998OtherMEDICARE RAILROAD
NC891140RMedicaid
NCG65631Medicare UPIN
NC2205099AMedicare PIN