Provider Demographics
NPI:1811951643
Name:ZIEMER, PAUL MCLAIN (IDC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MCLAIN
Last Name:ZIEMER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 TINIAN CIR
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-3937
Mailing Address - Country:US
Mailing Address - Phone:805-240-2041
Mailing Address - Fax:
Practice Address - Street 1:NAVAL AMBULATORY CARE CLINIC POINT MUGU
Practice Address - Street 2:1 DISPENSARY RD, BLDG 5
Practice Address - City:POINT MUGU NAWC
Practice Address - State:CA
Practice Address - Zip Code:93042-0001
Practice Address - Country:US
Practice Address - Phone:805-989-3916
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710L1002X1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman