Provider Demographics
NPI:1871540138
Name:ZIMMERMAN, STANLEY J (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:J
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:14416 W MEEKER BLVD
Practice Address - Street 2:BLDG C
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5284
Practice Address - Country:US
Practice Address - Phone:623-583-5083
Practice Address - Fax:623-583-5157
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110065585OtherRAILROAD MEDICARE PIN
AZ208977Medicaid
AZ110065585OtherRAILROAD MEDICARE PIN
AZ208977Medicaid