Healthcare Provider Details

I. General information

NPI: 1215324660
Provider Name (Legal Business Name): GEOFFREY ALOYS BADER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 07/21/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG UNIT
APO AE
09461-5115
US

IV. Provider business mailing address

48TH MDG UNIT 5115
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number29945
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number29945
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: