MEDICARE: KENNETH WAXMAN 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	174400000X	Specialist	G32872	CA

General Provider Information

NPI Number	:	1821068214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WAXMAN MD

Provider Business Mailing Address
First Line	:	1187 COAST VILLAGE RD
Second Line	:	492
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2737
Country	:	US
Telephone Number	:	805-569-7316
Fax Number	:	805-569-7317

Provider Business Practice Location Address
First Line	:	320 W PUEBLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4311
Country	:	US
Telephone Number	:	805-569-7316
Fax Number	:	805-569-7317

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/29/2007

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