Provider Demographics
NPI:1669593323
Name:EVAN J ZIMMER MD PA
Entity type:Organization
Organization Name:EVAN J ZIMMER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-673-3101
Mailing Address - Street 1:7100 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7355
Mailing Address - Country:US
Mailing Address - Phone:305-673-3101
Mailing Address - Fax:954-967-0109
Practice Address - Street 1:975 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE 308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33140-3329
Practice Address - Country:US
Practice Address - Phone:305-673-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11136Medicare ID - Type Unspecified