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Organization
EAST TEXAS FUNCTIONAL MEDICINE CENTER, LLC
Active
Organization
EAST TEXAS FUNCTIONAL MEDICINE CENTER, LLC
Active
Other names
Integrative Health Matters
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUY OTIS DANIELSON MD (MD/OWNER)
(903) 595-8077
Entity
Organization
Contact information
Practice address
419 WSW LOOP 323 STE 400, TYLER, TX 75701-7063
(903) 595-8077
(903) 363-1541
Mailing address
419 WSW LOOP 323 STE 400, TYLER, TX 75701-7063
(903) 595-8077
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
Other
Enumeration date
09/29/2020
Last updated
12/07/2020
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