Provider Demographics
NPI:1134121999
Name:MUSSARAT, PERVEZ (MD)
Entity Type:Individual
Prefix:
First Name:PERVEZ
Middle Name:
Last Name:MUSSARAT
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 1:15784 MEDICAL ARTS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1446
Mailing Address - Country:US
Mailing Address - Phone:985-542-9441
Mailing Address - Fax:985-542-9414
Practice Address - Street 1:15784 MEDICAL ARTS DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1446
Practice Address - Country:US
Practice Address - Phone:985-542-9441
Practice Address - Fax:985-542-9414
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08635R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1932396Medicaid
LA0565390002OtherCIGNA
LA691600OtherAETNA
LA1932396Medicaid
LA691600OtherAETNA
LA5R020Medicare ID - Type Unspecified