Waxman, Jack

Waxman, Jack is an individual health care provider with primary practice located at 4015 Quartz Dr , Santa Rosa CA 95405-5580. He recently has only one registered license in Allopathic & Osteopathic Physicians / Rheumatology, which is considered as his primary health care specialty. Waxman, Jack can be contacted via phone (707) 481-7215.

Contact Information

Primary practice address
4015 Quartz Dr Santa Rosa CA 95405-5580
Phone: (707) 481-7215
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X G23398 California

Profile Details

NPI number 1104824994
LBN Legal business name Waxman, Jack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2005
Last updated Mar 27th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104824994 NPPES
California Other 660002485 RAILROAD MEDICARE
California MEDICAID 00G233980 RAILROAD MEDICARE
California Other 00G233980 RAILROAD MEDICARE

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