Robert Pereyra, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

MC0957 Issued in ID

Practice address

700 W Ironwood Dr Ste 350
Coeur D Alene, ID 83814-4487

Phone

(208) 625-5222

Fax

(208) 625-5223

NPI assigned

Jan 30, 2007

Last updated

Jul 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1841336138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-5222",
            "fax_number": "208-625-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR STE 350",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144487",
            "telephone_number": "208-625-5222",
            "fax_number": "208-625-5223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1560 E. Chevy Chase Dr.",
            "address_2": "Suite 430",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "912064197",
            "country_code": "US",
            "telephone_number": "818-243-1135",
            "fax_number": "818-243-9332",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1215 N Beaver St",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860013126",
            "country_code": "US",
            "telephone_number": "928-773-2200",
            "fax_number": "928-773-2151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREYRA",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "G34124",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ID",
            "license": "MC0957",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "59047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Ann Penberthy, D.D.S
• Timothy Walter Penberthy, D.D.S.
• Brett A Penney, M.D.
• Elaina Penney, RN
• Michelle Pereira
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• Alexander Joseph Perry, RN

• Vascular Surgery Physician in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Vascular Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.