Individual
GUY O DANIELSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1814 ROSELAND BLVD, SUITE 200, TYLER, TX 75701-4244
(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
E7042
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137457111
—
TX
01
—
8K6370
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/29/2006
Last updated
02/02/2016
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