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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