Provider Demographics
NPI:1366487316
Name:GOEPFERT, ALICE R (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:R
Last Name:GOEPFERT
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18587207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000093755Medicaid
AL009948505Medicaid
AL009948515Medicaid
AL009948485Medicaid
AL009948525Medicaid
AL009948545Medicaid
AL009948535Medicaid
AL051521750OtherBLUE CROSS
AL051524351OtherBLUE CROSS
AL051524354OtherBLUE CROSS
AL000093755OtherBLUE CROSS
AL009970345Medicaid
AL009970365Medicaid
AL051517987OtherBLUE CROSS
AL051524353OtherBLUE CROSS
AL000025511OtherBLUE CROSS
AL009970355Medicaid
AL000025511Medicaid
AL009936045Medicaid
AL009948495Medicaid