Individual
MR. PETER CARL ZIMMERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1449 E 17TH STREET, IDAHO FALLS, ID 83404-6236
(208) 529-6600
(208) 529-6603
Mailing address
1449 E 17TH STREET, IDAHO FALLS, ID 83404-6236
(208) 529-6600
(208) 529-6603
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M3855
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006162
REGENCE BLUE SHIELD
ID
01
—
09761
BLUE CROSS
ID
Enumeration date
01/17/2007
Last updated
11/19/2007
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