Provider Demographics
NPI:1558674523
Name:AHL, SCOTT GEROLD (DO)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:GEROLD
Last Name:AHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE # L4640
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 W SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2543
Practice Address - Country:US
Practice Address - Phone:805-641-5620
Practice Address - Fax:805-641-5621
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A-12063207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism