Healthcare Provider Details

I. General information

NPI: 1356411177
Provider Name (Legal Business Name): JEFFREY MICHAEL RIMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

21 HOCHELAGA RD
SOUTH HERO VT
05486-4808
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0420006409
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: