Provider Demographics
NPI:1083651210
Name:PERVEZ, ASLAM (MD)
Entity Type:Individual
Prefix:
First Name:ASLAM
Middle Name:
Last Name:PERVEZ
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 1:2149 E WARNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3494
Mailing Address - Country:US
Mailing Address - Phone:480-610-6100
Mailing Address - Fax:
Practice Address - Street 1:2620 N 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1153
Practice Address - Country:US
Practice Address - Phone:602-277-4429
Practice Address - Fax:602-265-0271
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35476207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35476OtherMEDICAL LICENSE
AZ104559Medicaid
F44950Medicare UPIN
AZ104559Medicaid