MEDICARE: MR. BRYAN ZIMMERMAN

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	106E00000X	Assistant Behavior Analyst	1174928931	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1972047496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN ZIMMERMAN

Provider Business Mailing Address
First Line	:	11811 CYPRESS HILL CIR
Second Line	:	NONE
City	:	TAMPA
State	:	FL
Zip	:	33626-3672
Country	:	US
Telephone Number	:	813-444-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	11811 CYPRESS HILL CIR
Second Line	:	NONE
City	:	TAMPA
State	:	FL
Zip	:	33626-3672
Country	:	US
Telephone Number	:	813-444-8413
Fax Number	:

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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