Healthcare Provider Details

I. General information

NPI: 1679192108
Provider Name (Legal Business Name): CASEY W. PYLE, DO, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N BRENT ST STE 505
VENTURA CA
93003-2840
US

IV. Provider business mailing address

168 N BRENT ST STE 505
VENTURA CA
93003-2840
US

V. Phone/Fax

Practice location:
  • Phone: 805-648-3902
  • Fax: 805-648-4014
Mailing address:
  • Phone: 805-648-3902
  • Fax: 805-648-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY WARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-648-3902