Provider Demographics
NPI:1942688684
Name:GERON, NATHANIEL DUNCAN (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:DUNCAN
Last Name:GERON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DUNCAN
Other - Middle Name:
Other - Last Name:GERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3899 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7515
Mailing Address - Country:US
Mailing Address - Phone:832-323-9230
Mailing Address - Fax:
Practice Address - Street 1:3899 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7515
Practice Address - Country:US
Practice Address - Phone:832-323-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09725363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA09725OtherSTATE LICENSE
TX455224YV3COtherMEDICARE P-TAN USP
TX455224YV3COtherMEDICARE P-TAN USP
TX8198NSOtherBCBS - USA