Healthcare Provider Details

I. General information

NPI: 1831487040
Provider Name (Legal Business Name): BRYAN E PEREY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 09/13/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 S NEW ST
DOVER DE
19904-3540
US

IV. Provider business mailing address

640 S. STATE ST MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4070
  • Fax: 302-672-2315
Mailing address:
  • Phone: 302-674-4070
  • Fax: 302-672-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC5-0000773
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000773
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: