Provider Demographics
NPI:1083648547
Name:AXLER, JEANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:M
Last Name:AXLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3205 OCEAN PARK BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3239
Mailing Address - Country:US
Mailing Address - Phone:310-452-8345
Mailing Address - Fax:310-452-8347
Practice Address - Street 1:3205 OCEAN PARK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3240
Practice Address - Country:US
Practice Address - Phone:310-452-8345
Practice Address - Fax:310-452-8347
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40424208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40424Medicare PIN
CAA85454Medicare UPIN