MEDICARE: BRYAN EDWARD BRUNS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G-29642	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437184975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN EDWARD BRUNS M.D.

Provider Business Mailing Address
First Line	:	1759 BERYL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2214
Country	:	US
Telephone Number	:	858-442-8145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1759 BERYL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2214
Country	:	US
Telephone Number	:	858-535-0091
Fax Number	:	858-535-0080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	12/12/2024

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