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
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801905674
DR. DANIELSON'S NPI NUMBER
TX
Enumeration date
09/29/2020
Last updated
12/07/2020
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