=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588641708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT M ZIMMER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13170 RAVENNA ROAD SUITE 200
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024-7032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-542-6363
-----------------------------------------------------
Fax | 440-279-1582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7590 AUBURN RD STE 14
-----------------------------------------------------
City | CONCORD TWP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-9176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-354-1899
-----------------------------------------------------
Fax | 440-354-1845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 35.077097
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 35.077097
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------