Provider Demographics
NPI:1679558811
Name:ZIMMERMAN, ROBERT P (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:1338 S HOPE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2902
Practice Address - Country:US
Practice Address - Phone:213-724-5634
Practice Address - Fax:213-742-5644
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77580174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G775800Medicaid
CAP00263208OtherRR MEDICARE
CAWG77580BMedicare PIN
CAWG77580GMedicare PIN
CAWG77580AMedicare PIN
CA00G775800Medicaid
CAWG77580JMedicare PIN
CAG48232Medicare UPIN
CAWG77580FMedicare PIN