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Organization

GUY O DANIELSON III, M.D., P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GUY O DANIELSON III M.D. (PRESIDENT)
(903) 595-8077
Entity
Organization

Contact information

Practice address
1814 ROSELAND BLVD, SUITE 200, TYLER, TX 75701-4234
(903) 595-8077
(903) 363-1541
Mailing address
PO BOX 6930, TYLER, TX 75711-6930
(903) 595-8077
(903) 363-1541

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0031KV
BLUE CROSS BLUE SHIELD
05
168693301
TX
Enumeration date
08/29/2006
Last updated
02/02/2016
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