MEDICARE: LISA WEBER ZIMMERER PA-C

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	363A00000X	Physician Assistant	PA09531	TX

General Provider Information

NPI Number	:	1457758336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WEBER ZIMMERER PA-C

Provider Business Mailing Address
First Line	:	1429 BLUEBONNET DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-1445
Country	:	US
Telephone Number	:	214-908-8674
Fax Number	:

Provider Business Practice Location Address
First Line	:	7367 N BEACH ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-1883
Country	:	US
Telephone Number	:	682-204-0042
Fax Number	:

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

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	10/02/2018

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