MEDICARE: STEPHEN BRUCE ZIMMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	98-00434	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080123998	OTHER	NC	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457424046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN BRUCE ZIMMER M.D.

Provider Business Mailing Address
First Line	:	294 N HIGHWAY 16
Second Line	:	SUITE A
City	:	DENVER
State	:	NC
Zip	:	28037-8011
Country	:	US
Telephone Number	:	704-660-4041
Fax Number	:	704-489-2900

Provider Business Practice Location Address
First Line	:	294 N HIGHWAY 16
Second Line	:	SUITE A
City	:	DENVER
State	:	NC
Zip	:	28037-8011
Country	:	US
Telephone Number	:	704-660-4041
Fax Number	:	704-489-2900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/18/2017

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