Provider Demographics
NPI:1700013638
Name:LONG, BRYAN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:EDWARD
Last Name:LONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:NAVAL MEDICAL RESEARCH AND TRAINING COMMAND SAN DIEGO
Mailing Address - Street 2:34800 BOB WILSON DRIVE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92009
Mailing Address - Country:US
Mailing Address - Phone:619-532-5432
Mailing Address - Fax:619-532-8055
Practice Address - Street 1:NAVAL MEDICAL RESEARCH AND TRAINING COMMAND SAN DIEGO
Practice Address - Street 2:34800 BOB WILSON DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92009
Practice Address - Country:US
Practice Address - Phone:619-532-5432
Practice Address - Fax:619-532-8055
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2024-01-08
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Provider Licenses
StateLicense IDTaxonomies
CA1518032083P0500X
CAC-151803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine