JACK WAXMAN


Address: 1701 4th St Ste 210, Santa Rosa, CA 95404-3661
Phone: 7075736942

JACK WAXMAN (NPI# 1104824994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104824994
Entity Type Individual
Full Name JACK WAXMAN
Credential M.D.
Practice Address 1701 4th St Ste 210
Santa Rosa
CA 95404-3661
Mailing Address 3536 Mendocino Ave
Ste 200
Santa Rosa
CA 95403-3634
Practice Telephone 7075736942
Practice Fax Number 7075756038
Mailing Telephone 7075256485
Mailing Fax Number 7075756038
Enumeration Date 2005-07-14
Last Update Date 2019-01-11
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RR0500X Internal Medicine
Specialization: Rheumatology
G23398 CA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA BLUE SHIELD OF CALIFORNIA 00G233980 01
CA 00G233980 05
CA RAILROAD MEDICARE 660002485 01

Office Location

Street Address 1701 4TH ST STE 210
City SANTA ROSA
State CA
Zip Code 95404-3661

Providers in the same location

NPI Name Taxonomy Address Enumeration
1871008318 Northern California Medical Assoc Inc Dietitian, Registered 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 2017-12-06
1801348859 Heather Jeanne Kehres Physician Assistant 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 2016-10-25
1639620768 Jennifer L Logan Dietitian, Registered 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 2016-10-24
1477965507 Isha Shrestha Internal Medicine 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 2014-05-23
1134222458 Kent William Blakely Internal Medicine 1701 4th St Ste 210, Santa Rosa, CA 95404 2006-09-06
1497739114 Yuichiro David Nakai Internal Medicine 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 2005-12-06

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205442217 David Lee Dutton Counselor 201 S. E Street, Santa Rosa, CA 95404 2020-09-16
1114492162 Jesse Earl Rathbun Jr. Ophthalmology 1920 Grace Dr., Santa Rosa, CA 95404 2018-10-05
1568958437 Bianca Avina Marriage & Family Therapist 95 Montgomery Dr. #112, Santa Rosa, CA 95404 2018-07-03
1366940504 New Leaf Counseling and Psychotherapy Marriage & Family Therapist 1030 2n Street, Suite B, Santa Rosa, CA 95404 2018-01-23
1659884864 Jessica Vargas Lopez Counselor 3333 Chanate Road, Santa Rosa, CA 95404 2017-11-09
1982135992 Gaea Keridwyn Coon Marriage & Family Therapist 884 Third Street, Suite D, Santa Rosa, CA 95404 2017-03-22
1376084699 Empire Traditional Chinese Medicine Acupuncturist 1030 Second St, Santa Rosa, CA 95404 2017-03-20
1356888705 Webster Surgery Center, Lp Clinic/Center 730 Bennett Valley Road, Santa Rosa, CA 95404 2017-01-24
1205295979 Sandra Lee Krikorian Social Worker 101 E Street, Suite 312, Santa Rosa, CA 95404 2016-02-23
1396134615 The Center for Body Oriented Psychotherapy & Wellness Psychologist 1626 Fourth Street, Santa Rosa, CA 95404 2015-01-12
Find all providers in zip 95404

Taxonomy Information

Taxonomy Code 207RR0500X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Rheumatology

Taxonomy Definition

An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1639516149 Donald Lloyd Whisler Internal Medicine 500 Doyle Park Dr Ste 300, Santa Rosa, CA 95405-4559 2013-05-24
1841494275 Lisa B. Kremer, M.d. Internal Medicine 4725-a Hoen Ave, Santa Rosa, CA 95405-7862 2007-06-11
1144262213 Lisa B Kremer Internal Medicine 4725 Hoen Ave Ste A, Santa Rosa, CA 95405-9405 2006-06-12
1891344305 Northern California Medical Assoc Inc Internal Medicine 4690 Hoen Ave, Santa Rosa, CA 95405-7823 2019-09-06
1710457361 Northern California Medical Assoc Internal Medicine 1701 4th St Ste 100, Santa Rosa, CA 95404-3661 2018-11-27
1588164909 Northern California Medical Assoc Inc Internal Medicine 990 Sonoma Ave Ste 18, Santa Rosa, CA 95404 2018-02-13
1386031268 David Maniscalco Internal Medicine 3883 Airway Dr Ste 130, Santa Rosa, CA 95403-1671 2015-04-19
1144592205 Khashayar Khosraviani Internal Medicine 401 Bicentennial Way, Dept of Rheumatology Suite 160, Santa Rosa, CA 95403-2149 2012-02-06
1124102298 Richard T. Zweig Internal Medicine 401 Bicentennial Way, Santa Rosa, CA 95403-2149 2006-10-25
1134222458 Kent William Blakely Internal Medicine 1701 4th St Ste 210, Santa Rosa, CA 95404 2006-09-06
Find all providers in SANTA ROSA

Competitor

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City SANTA ROSA
Zip Code 95404

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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