Provider Demographics
NPI:1083882096
Name:HABERMACHER, GEOFFREY MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:MICHAEL
Last Name:HABERMACHER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:2119 E SOUTH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2454
Practice Address - Country:US
Practice Address - Phone:334-613-7070
Practice Address - Fax:334-613-7072
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35275208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL189564Medicaid
016872U23Medicare PIN