Provider Demographics
NPI:1619090495
Name:BRY, VERNON ARTHUR JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ARTHUR
Last Name:BRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7335
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-0335
Mailing Address - Country:US
Mailing Address - Phone:530-573-8952
Mailing Address - Fax:
Practice Address - Street 1:960 EMERALD BAY ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150
Practice Address - Country:US
Practice Address - Phone:530-573-8952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2380802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPIN00G238080Medicare ID - Type Unspecified
A89388Medicare UPIN