Individual
DR. STACY C ZIMMERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1125 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1908
(479) 713-8701
(479) 713-8719
Mailing address
PO BOX 251420, LITTLE ROCK, AR 72225-1420
(501) 686-8000
(501) 526-5148
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E-3258
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03090020200
QUALCHOICE
AR
05
—
149638001
—
AR
01
—
770272601
BREASTCARE
AR
01
—
E3258
STATE LICENSE
AR
Enumeration date
06/26/2006
Last updated
01/06/2023
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