Organization
CHILDREN'S MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE FRANKLIN ZIMMERMAN MD (PRESIDENT)
(907) 268-6725
Entity
Organization
Contact information
Practice address
4131 UNIVERSITY BLVD S, 16, JACKSONVILLE, FL 32216-4326
(907) 733-7408
(904) 733-7668
Mailing address
4131 UNIVERSITY BLVD S, 16, JACKSONVILLE, FL 32216-4326
(907) 733-7408
(904) 733-7668
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00149
BCBS
FL
Enumeration date
11/10/2005
Last updated
08/22/2020
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