Provider Demographics
NPI:1881676930
Name:MACHEN, GERALD M (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:MACHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1921
Mailing Address - Country:US
Mailing Address - Phone:256-739-1759
Mailing Address - Fax:256-739-0027
Practice Address - Street 1:1948 AL HIGHWAY 157 STE 101
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0642
Practice Address - Country:US
Practice Address - Phone:256-739-4131
Practice Address - Fax:256-739-6027
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL11516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51026286OtherBCBS OF AL
AL1164743068Medicaid
AL117970Medicaid
ALC72536Medicare UPIN
AL080080739Medicare PIN