Provider Demographics
NPI:1992210710
Name:GEIGER, ETHAN CALEB (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:CALEB
Last Name:GEIGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 STILLWATER RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-7066
Mailing Address - Country:US
Mailing Address - Phone:254-723-0067
Mailing Address - Fax:
Practice Address - Street 1:300 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7934
Practice Address - Country:US
Practice Address - Phone:254-235-9355
Practice Address - Fax:254-235-2135
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant