Provider Demographics
NPI:1508164948
Name:BRYAN M. PEREIRA, M.D., P.C.
Entity Type:Organization
Organization Name:BRYAN M. PEREIRA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-546-3952
Mailing Address - Street 1:2777 YULUPA AVENUE
Mailing Address - Street 2:SUITE # 274
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-546-3592
Mailing Address - Fax:707-546-3990
Practice Address - Street 1:1111 SONOMA AVE
Practice Address - Street 2:SUITE # 320
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-546-3592
Practice Address - Fax:707-546-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70278207T00000X
CAA-70278207T00000X
WI39920207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000043085Medicare PIN
G72236Medicare UPIN