Provider Demographics
NPI:1427880608
Name:ACCESS ALLERGY EAST TEXAS PLLC
Entity type:Organization
Organization Name:ACCESS ALLERGY EAST TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNKHOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-471-1857
Mailing Address - Street 1:655 E REDD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1242
Mailing Address - Country:US
Mailing Address - Phone:915-303-5522
Mailing Address - Fax:
Practice Address - Street 1:6115 NEW COPELAND RD STE 440
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6360
Practice Address - Country:US
Practice Address - Phone:903-405-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty