Provider Demographics
NPI:1295988590
Name:HEROLD, SCOTT DAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVIS
Last Name:HEROLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SIREN ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2252
Mailing Address - Country:US
Mailing Address - Phone:831-375-8637
Mailing Address - Fax:
Practice Address - Street 1:10 SIREN ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2252
Practice Address - Country:US
Practice Address - Phone:831-375-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34405207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45914Medicare UPIN
CA00G34405Medicare PIN