MEDICARE: JONATHAN FREDRIC WAXER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	A163392	CA

General Provider Information

NPI Number	:	1629575337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN FREDRIC WAXER MD

Provider Business Mailing Address
First Line	:	4950 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5821
Country	:	US
Telephone Number	:	323-783-2841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	07/13/2023

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