East Texas Functional Medicine Center, LLC
Preventive Medicine, Public Health & General Preventive Medicine in Tyler, TX. Organization (NPI-2).
NPI number1245847672
StatusActive
Last updated in NPPESDec 7, 2020
Details
- NPI
- 1245847672
- Entity type
- Organization (NPI-2)
- Legal business name
- East Texas Functional Medicine Center, LLC
- Organization subpart
- No
- Enumeration date
- Sep 29, 2020
- Certification date
- Dec 7, 2020
- Last updated
- Dec 7, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2083P0901X | Preventive Medicine, Public Health & General Preventive Medicine | – | – | Yes |
| 207R00000X | Internal Medicine | – | – |
Other names
- Integrative Health Matters (Doing Business As)
Practice location
419 Wsw Loop 323 Ste 400Tyler, TX 75701-7063
Phone 903-595-8077 · Fax 903-363-1541
Mailing address
419 Wsw Loop 323 Ste 400Tyler, TX 75701-7063
Phone 903-595-8077
Authorized official
Guy Otis Danielson
MD/Owner
9035958077
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