Provider Demographics
NPI:1699909127
Name:EULER, BRYAN LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LEE
Last Name:EULER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 QUEENS WAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3115
Mailing Address - Country:US
Mailing Address - Phone:505-821-3899
Mailing Address - Fax:
Practice Address - Street 1:5304 QUEENS WAY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3115
Practice Address - Country:US
Practice Address - Phone:505-821-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM601103T00000X
NM095493103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP2323OtherPREVIOUSLY ASSIGNED MEDICAID NUMBER FOR NEW MEXICO- THIS WILL HOPEFULLY CONTINUE
NMNM302609Medicare PIN