Provider Demographics
NPI:1316933732
Name:ZIMBUREAN, PATRICIA DULEY (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DULEY
Last Name:ZIMBUREAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12014 60TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8735
Mailing Address - Country:US
Mailing Address - Phone:989-370-2899
Mailing Address - Fax:
Practice Address - Street 1:12014 60TH ST NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8735
Practice Address - Country:US
Practice Address - Phone:989-370-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2904509Medicaid
MI2904509Medicaid
MIF00423Medicare UPIN
MI0690012OtherBLUE SHIELD