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General NPI Number Information
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NPI Number | 1932180452
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL GROUP PA
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4131 UNIVERSITY BLVD S 16
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4326
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Country | US
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Telephone | 907-733-7408
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Fax | 904-733-7668
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Provider Business Mailing Address
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Address Line | 4131 UNIVERSITY BLVD S 16
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4326
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Country | US
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Telephone | 907-733-7408
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Fax | 904-733-7668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DALE FRANKLIN ZIMMERMAN
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Credential | MD
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Telephone | 907-268-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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