Provider Demographics
NPI:1770576571
Name:ZIMMERMAN, BRETT THOMAS (DO)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:THOMAS
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MEDICAL PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5653
Mailing Address - Country:US
Mailing Address - Phone:817-279-1776
Mailing Address - Fax:817-573-2239
Practice Address - Street 1:1212 MEDICAL PLAZA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5653
Practice Address - Country:US
Practice Address - Phone:817-279-1776
Practice Address - Fax:817-573-2239
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016668207V00000X
AZ008805207V00000X
TXU3763207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2325684Medicaid
MIM74460290Medicare PIN
OHZI306741Medicare ID - Type Unspecified
OH2325684Medicaid