Healthcare Provider Details

I. General information

NPI: 1093925588
Provider Name (Legal Business Name): AMY C. ZIMMERMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY C. GAINES

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11365 DORSETT RD.
MARYLAND HEIGHTS MO
63043
US

IV. Provider business mailing address

11365 DORSETT RD.
MARYLAND HEIGHTS MO
63043
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-6430
  • Fax: 314-872-6500
Mailing address:
  • Phone: 314-872-6430
  • Fax: 314-872-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number26450
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: