Basic Information
| Provider Information | |||||||||
| NPI: | 1215324660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADER | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | ALOYS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DRIVE, QUALITY SERVICES/7TH FLOOR | ||||||||
| Address2: | ATTN: MCHE-ZQQ, JBSA FT SAM HOUSTON, TX | ||||||||
| City: | APO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162338 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 WILFORD HALL LOOP BLDG 4554 | ||||||||
| Address2: | |||||||||
| City: | JBSA LACKLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782365638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102924980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 07/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 29945 | NE | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | 29945 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.