Guy O Danielson III, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

E7042 Issued in TX

Practice address

1814 Roseland Blvd
Suite 200
Tyler, TX 75701-4244

Phone

(903) 595-8077

Fax

(903) 363-1541

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Texas Functional Medicine Center, LLC

  • Public Health & General Preventive Medicine Physician
  • Tyler, TX
  • NPI 1245847672
  Medicare reassignment NPD Authorized official
• Guy O Danielson III, M.D., P.a.

  • Neurological Surgery Physician
  • Tyler, TX
  • NPI 1588773345
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1801905674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6930",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757116930",
            "telephone_number": "903-595-8077",
            "fax_number": "903-363-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 ROSELAND BLVD",
            "address_2": "SUITE 200",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757014244",
            "telephone_number": "903-595-8077",
            "fax_number": "903-363-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIELSON",
        "first_name": "GUY",
        "middle_name": "O",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "E7042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137457111",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8K6370",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel & Max, LLC
• Joyce Daniel
• Chastity Daniels, RDH, RN
• Tracey Rochelle Daniels, COTA, LVN
• William Douglas Daniels, MD
• Lesa Danley, LCDC
• David Danly, MD
• Calvin Duy Dao, MD
• Letha E Darlin - Reynolds, PHARM. D
• Shamaya Darnell, PTA

• Neurological Surgery Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Neurological Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.