Healthcare Provider Details

I. General information

NPI: 1235173253
Provider Name (Legal Business Name): JULIE H. BRYSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/16/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E MOUNTAIN VIEW ST
BARSTOW CA
92311-3053
US

IV. Provider business mailing address

35379 CABRINI DR
YUCAIPA CA
92399-4817
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-3321
  • Fax: 907-442-7250
Mailing address:
  • Phone: 907-442-3321
  • Fax: 907-442-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA64881
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA64881
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-1599
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: