Jack Waxman
Rheumatology
1701 4th St Ste 210
Santa Rosa
, California 95404-3661
Jack Waxman
Rheumatology
1701 4th St Ste 210
Santa Rosa
, California 95404-3661
(707) 575-6038
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About
Features
Specialties
- Rheumatology
Languages spoken
- English
Location
First Address
- Jack Waxman
- 3536 Mendocino Ave Ste 200
- Santa Rosa, CA
- Zip : 95403-3634
- Fax : (707) 575-6038
- Phone : (707) 525-6485
Second Address
- Jack Waxman
- 1701 4th St Ste 210
- Santa Rosa, CA
- Zip : 95404-3661
- Fax : (707) 575-6038
- Phone : (707) 573-6942
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RR0500X | Rheumatology | G23398 | CA |
National Provider Identifier
| NPI | 1104824994 |
|---|---|
| Provider Name | Jack Waxman |
| First Address | Santa Rosa, CA 95403-3634 |
| Second Address | Santa Rosa, CA 95404-3661 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/07/2005 |
| Last Update Date | 11/01/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00G233980 | (05) | CA |
| 00G233980 | BLUE SHIELD OF CALIFORNIA (01) | CA |
| 660002485 | RAILROAD MEDICARE (01) | CA |
| B61647 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.