Provider Demographics
NPI:1538154984
Name:PASSLER, MICHAEL ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:PASSLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S SAINT ANDREWS ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2675
Mailing Address - Country:US
Mailing Address - Phone:334-794-6874
Mailing Address - Fax:334-794-6874
Practice Address - Street 1:335 S SAINT ANDREWS ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2675
Practice Address - Country:US
Practice Address - Phone:334-794-6874
Practice Address - Fax:334-794-6874
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL480103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
71063Medicare ID - Type Unspecified
R35787Medicare UPIN