Active NPI
Paul David Zimmerman, PA-C
- Physician Assistant
- Lackland Afb, TX
National Provider Identifier
1104699339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA17679
- Practice address
- 1100 Wilford Hall Loop
Lackland Afb, TX 78236-5638 - Phone
- (210) 292-7447
- NPI assigned
- Oct 31, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Physician Assistant | 363A00000X | PA17679 | TX | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop
Lackland Afb, TX 78236-5638
Mailing address
1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA17679 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731456000000",
"number": "1104699339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"city": "LACKLAND AFB",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-292-7447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIMMERMAN",
"first_name": "PAUL",
"middle_name": "DAVID",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-10-31",
"last_updated": "2024-11-13",
"certification_date": "2024-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA17679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackland Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.