MEDICARE: STANLEY JAY 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	207R00000X	Internal Medicine Physician	C5307	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1275712572	OTHER	TX	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C5307	OTHER	TX	TEXAS MEDICAL LICENSE

General Provider Information

NPI Number	:	1588675870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY JAY ZIMMERMAN M.D.

Provider Business Mailing Address
First Line	:	7707 FANNIN ST
Second Line	:	SUITE 250
City	:	HOUSTON
State	:	TX
Zip	:	77054-1926
Country	:	US
Telephone Number	:	713-797-9999
Fax Number	:	713-795-4651

Provider Business Practice Location Address
First Line	:	7707 FANNIN ST
Second Line	:	SUITE 250
City	:	HOUSTON
State	:	TX
Zip	:	77054-1926
Country	:	US
Telephone Number	:	713-797-9999
Fax Number	:	713-795-4651

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	02/26/2008

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