Provider Demographics
NPI:1588811400
Name:WALSER, BRYAN LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LEROY
Last Name:WALSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5223
Mailing Address - Country:US
Mailing Address - Phone:510-501-7046
Mailing Address - Fax:
Practice Address - Street 1:309 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-5223
Practice Address - Country:US
Practice Address - Phone:510-501-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83742208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice