Provider Demographics
NPI:1801986203
Name:ZIMMER, JOHN WEST (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WEST
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 1:77 HERRICK ST
Mailing Address - Street 2:SUITE 201 THE MEDICAL BUILDING
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-3040
Mailing Address - Fax:978-927-0443
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:SUITE 201 THE MEDICAL BUILDING
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-3040
Practice Address - Fax:978-927-0443
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47354207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3056881Medicaid
MA3056881Medicaid
B97367Medicare UPIN