Provider Demographics
NPI:1831137991
Name:DEBRY, PETER W (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:DEBRY
Suffix:
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 1:2390 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5084
Mailing Address - Country:US
Mailing Address - Phone:702-825-2085
Mailing Address - Fax:702-852-5743
Practice Address - Street 1:2390 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5084
Practice Address - Country:US
Practice Address - Phone:702-825-2085
Practice Address - Fax:702-852-5743
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10470207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1831137991Medicaid
NVGB117ZMedicare PIN
NVH21732Medicare UPIN