Basic Information
| Provider Information | |||||||||
| NPI: | 1588675870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7707 FANNIN ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137979999 | ||||||||
| FaxNumber: | 7137954651 | ||||||||
| Practice Location | |||||||||
| Address1: | 7707 FANNIN ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137979999 | ||||||||
| FaxNumber: | 7137954651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C5307 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1275712572 | 01 | TX | GROUP NPI | OTHER | 0309064301 | 05 | TX | MEDICAID | C5307 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER |