Provider Demographics
NPI:1669914925
Name:GEYER, BLAISE (PA)
Entity type:Individual
Prefix:
First Name:BLAISE
Middle Name:
Last Name:GEYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6633 E HIGHWAY 290
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1172
Mailing Address - Country:US
Mailing Address - Phone:512-872-6868
Mailing Address - Fax:512-872-6870
Practice Address - Street 1:6633 E HIGHWAY 290
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1172
Practice Address - Country:US
Practice Address - Phone:512-872-6868
Practice Address - Fax:512-872-6870
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA10962363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant