Healthcare Provider Details

I. General information

NPI: 1780609958
Provider Name (Legal Business Name): ROY W ZIMMER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 S RUSSELL ST
MISSOULA MT
59801-8536
US

IV. Provider business mailing address

PO BOX 4165
MISSOULA MT
59806-4165
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-4906
  • Fax:
Mailing address:
  • Phone: 406-721-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number8077
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: