Healthcare Provider Details

I. General information

NPI: 1013919505
Provider Name (Legal Business Name): JEFFRY A ZIMMERMAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD ST FRANCIS EMERGENCY DEPARTMENT
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

1700 CAPEWAY RD
POWHATAN VA
23139-7323
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7066
  • Fax: 804-673-9531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0110001164
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001164
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: