Healthcare Provider Details

I. General information

NPI: 1306680244
Provider Name (Legal Business Name): JONATHAN ZIMMERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
CLARION PA
16214-8501
US

IV. Provider business mailing address

1 HOSPITAL DR
CLARION PA
16214-8501
US

V. Phone/Fax

Practice location:
  • Phone: 814-224-9500
  • Fax:
Mailing address:
  • Phone: 814-224-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT232744
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: