Provider Demographics
NPI:1750351151
Name:ZIMMER, SUZAN E (DO)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:E
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6381
Mailing Address - Country:US
Mailing Address - Phone:772-742-9270
Mailing Address - Fax:772-742-9278
Practice Address - Street 1:3255 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-6381
Practice Address - Country:US
Practice Address - Phone:772-742-9270
Practice Address - Fax:772-742-9278
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2973824001OtherCIGNA
FL281329OtherWELLCARE
FLP00053450OtherRAILROAD MEDICARE
FL57154XOtherMEDICARE ID
FL7380593OtherAETNA
FL020569100Medicaid
FL57154OtherBCBS
FL020569100Medicaid