Provider Demographics
NPI:1174504740
Name:GARBER, JEFFREY G (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:GARBER
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 1:12205 COUNTY LINE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7720
Mailing Address - Country:US
Mailing Address - Phone:256-759-9262
Mailing Address - Fax:
Practice Address - Street 1:610 AIRPORT RD SW STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4304
Practice Address - Country:US
Practice Address - Phone:256-429-4809
Practice Address - Fax:256-429-4163
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51018968OtherBLUE CROSS BLUE SHIELD
0004003540OtherAETNA IDENTIFICATION NO
630985310OtherTAX IDENTIFICATION NO
C36370Medicare UPIN
0004003540OtherAETNA IDENTIFICATION NO
080182432Medicare ID - Type UnspecifiedRAILROAD MEDICARE