Provider Demographics
NPI:1164911590
Name:PERVEZ, ESKARA (MD)
Entity Type:Individual
Prefix:
First Name:ESKARA
Middle Name:
Last Name:PERVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 MANASCO LN APT 6
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-6614
Mailing Address - Country:US
Mailing Address - Phone:217-685-7831
Mailing Address - Fax:
Practice Address - Street 1:124 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3619
Practice Address - Country:US
Practice Address - Phone:217-685-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2021-08-11
Deactivation Date:2018-12-13
Deactivation Code:
Reactivation Date:2019-01-22
Provider Licenses
StateLicense IDTaxonomies
MI4301115016390200000X
ALMD.42868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
5315092165OtherPHARMACY CS-1