Healthcare Provider Details

I. General information

NPI: 1720617848
Provider Name (Legal Business Name): ALEXIS BRIANNE ZIMMERMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS BRIANNE BRAID DO

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE STE 215
DU BOIS PA
15801-1464
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-2200
  • Fax: 814-372-2573
Mailing address:
  • Phone: 814-375-6560
  • Fax: 814-375-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS022908
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: