Active NPI
Brandon Lee Zimmer
- Dental Assistant
- Fort Leonard Wood, MO
National Provider Identifier
1306298104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- Practice address
- 5047 Virginia Ave
BLDG 500
Fort Leonard Wood, MO 65473-9126 - Phone
- (573) 596-0408
- Fax
- (573) 596-0314
- NPI assigned
- Jul 6, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | Primary |
Addresses
Primary practice location
5047 Virginia Ave
BLDG 500
Fort Leonard Wood, MO 65473-9126
Mailing address
5047 Virginia Ave
BLDG 500
Fort Leonard Wood, MO 65473-9126
Phone (573) 596-0408
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467763200000",
"number": "1306298104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5047 VIRGINIA AVE",
"address_2": "BLDG 500",
"city": "FORT LEONARD WOOD",
"state": "MO",
"postal_code": "654739126",
"telephone_number": "573-596-0408",
"fax_number": "573-596-0314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5047 VIRGINIA AVE",
"address_2": "BLDG 500",
"city": "FORT LEONARD WOOD",
"state": "MO",
"postal_code": "654739126",
"telephone_number": "573-596-0408",
"fax_number": "573-596-0314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIMMER",
"first_name": "BRANDON",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-06",
"last_updated": "2016-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Leonard Wood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.