Provider Demographics
NPI:1316021645
Name:AYERS, CONSTANCE J (MD)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:J
Last Name:AYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:JEAN
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4 HAMILTON LANDING
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949
Mailing Address - Country:US
Mailing Address - Phone:415-884-1840
Mailing Address - Fax:415-883-7127
Practice Address - Street 1:652 PETALUMA BLVED.
Practice Address - Street 2:SUITE H
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-823-7616
Practice Address - Fax:707-823-2803
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGO48999172V00000X
CAG048999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G489990OtherMEDICAL #
CAF09248Medicare UPIN
00G489990Medicare PIN
F09248Medicare UPIN