Healthcare Provider Details

I. General information

NPI: 1871789354
Provider Name (Legal Business Name): SCOTT MICHAEL AHLBRAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR H3580
STANFORD CA
94305-2200
US

IV. Provider business mailing address

1500 NORMAN AVE
SAN JOSE CA
95125-5321
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-7377
  • Fax: 650-725-8544
Mailing address:
  • Phone: 408-264-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA95711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: