=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831487040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYAN E PEREY PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2011
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 724 S NEW ST
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-674-4070
-----------------------------------------------------
Fax | 302-672-2315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 640 S. STATE ST MAIL CODE 3055
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19901-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-674-4070
-----------------------------------------------------
Fax | 302-672-2315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | C5-0000773
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | C5-0000773
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------