Provider Demographics
NPI:1669420931
Name:ZIMMERMAN, ROBERT A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S 20TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1100
Mailing Address - Country:US
Mailing Address - Phone:479-636-9669
Mailing Address - Fax:479-636-0743
Practice Address - Street 1:200 S 20TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-636-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4951208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology