Provider Demographics
NPI:1538256334
Name:ZIMMERMANN, ERIK OTTO (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:OTTO
Last Name:ZIMMERMANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-0178
Mailing Address - Country:US
Mailing Address - Phone:352-435-7849
Mailing Address - Fax:352-435-7904
Practice Address - Street 1:1208 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6314
Practice Address - Country:US
Practice Address - Phone:352-435-7849
Practice Address - Fax:352-435-7904
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2802213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35640OtherBLUE CROSS BLUE SHIELD
FLU77012Medicare UPIN
FL4079960002Medicare NSC
FL480034532Medicare PIN
FLE3104Medicare PIN