Healthcare Provider Details

I. General information

NPI: 1063494284
Provider Name (Legal Business Name): DAVID SETH ZIMMERMAN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N HIGLEY RD
GILBERT AZ
85234-1604
US

IV. Provider business mailing address

4088 E OLIVE AVE
GILBERT AZ
85234-7904
US

V. Phone/Fax

Practice location:
  • Phone: 480-543-2485
  • Fax:
Mailing address:
  • Phone: 480-539-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2615
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: