| Doctor Name: | DR. BRYAN W BOVITZ |
| NPI Number: | 1689824518 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PY00003930 |
| Business Practice Address: | 208 Casablanca Ave. 27 Sgomh Cannon Afb, NM - 881015014 |
| Business Phone Number: | 5757841108 |
| Business Fax Number: | 5757844624 |
| Mailing Address: | 208 Casablanca Ave., 27 Sgomh CANNON AFB |
| State: | NM |
| Postal Code: | 881015014 |
| Phone Number: | 5757841108 |
| Fax Number: | 5757844624 |
| NPI Enumeration Date: | 09/29/2008 |
| NPI Last Update Date: | 09/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY00003930 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |