Provider Demographics
NPI:1922395797
Name:BRYER, LAWRENCE W (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:W
Last Name:BRYER
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 1:4100 REDWOOD RD
Mailing Address - Street 2:STE 10, PMB #206
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2363
Mailing Address - Country:US
Mailing Address - Phone:510-301-7738
Mailing Address - Fax:
Practice Address - Street 1:5131 PARKRIDGE DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619
Practice Address - Country:US
Practice Address - Phone:510-531-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG456192084P0800X
CAGFE456192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry