Esther A. Penn, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

A82492 Issued in CA

Practice address

3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634

Phone

(707) 525-6482

Fax

(707) 573-6918

NPI assigned

Nov 15, 2006

Last updated

Apr 24, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Esther A Maksymovitch Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398297600000",
    "number": "1215009048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 2ND ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954046608",
            "telephone_number": "707-546-9800",
            "fax_number": "707-546-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE",
            "address_2": "STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-525-6482",
            "fax_number": "707-573-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "ESTHER",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2014-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A82492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A824920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ESTHER",
            "last_name": "MAKSYMOVITCH",
            "middle_name": "A",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jonathan A. Peng, M.D.
• Emily G Pengelly, PA-C, MD
• Charles William Pengra, PH.D.
• Tom Penland
• Daniel R. Penn, MD
• Aleae T. Pennette, DC,
• Gregory P Penning, R.T.(R)(CT)ARRT
• Jody Lynn Pennycook, PA
• Daniel Peoples
• Frank Peoples

• Ophthalmology Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.