Provider Demographics
NPI:1295830644
Name:GEARY, LOUISE ROACH (MD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ROACH
Last Name:GEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ALISON DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3369
Mailing Address - Country:US
Mailing Address - Phone:256-329-2938
Mailing Address - Fax:256-329-2938
Practice Address - Street 1:3316 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3369
Practice Address - Country:US
Practice Address - Phone:256-329-2938
Practice Address - Fax:256-329-2938
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4307174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51058954OtherBLUE CROSS BLUE SHIELD
AL000058954Medicaid
ALC79047Medicare UPIN
AL000058954Medicaid