Provider Demographics
NPI:1417177411
Name:GEIGER, WENDELL GEORGE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:GEORGE
Last Name:GEIGER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 MEADOWHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4016
Mailing Address - Country:US
Mailing Address - Phone:817-249-6341
Mailing Address - Fax:
Practice Address - Street 1:2825 STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1377
Practice Address - Country:US
Practice Address - Phone:817-257-7940
Practice Address - Fax:817-257-7279
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant