MEDICARE: MARK ZIMMERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	97-414	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376514646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ZIMMERMAN M.D.

Provider Business Mailing Address
First Line	:	5967 SUN APPELLO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3447
Country	:	US
Telephone Number	:	702-489-5120
Fax Number	:	702-489-5120

Provider Business Practice Location Address
First Line	:	5967 SUN APPELLO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3447
Country	:	US
Telephone Number	:	702-489-5120
Fax Number	:	702-489-5120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	06/23/2010

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