# VITALITY CLINICS OF EAST TEXAS, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508206442
- **Authorized official:** DR. STEVEN KIP YODER M.D. (OWNER)
- **Authorized official phone:** (903) 525-9432

## Contact information

- **Practice address:** 455 RICE RD, 102, TYLER, TX 75703-3604
- **Practice address phone:** (903) 525-9432
- **Practice address fax:** (903) 525-9455
- **Mailing address:** 455 RICE RD, 102, TYLER, TX 75703-3604
- **Mailing address phone:** (903) 525-9432
- **Mailing address fax:** (903) 525-9455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/25/2013
- **Last updated:** 06/25/2013