Provider Demographics
NPI:1417518846
Name:PERVEZE, ISMA (MD)
Entity Type:Individual
Prefix:
First Name:ISMA
Middle Name:
Last Name:PERVEZE
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 1:1 HOSPITAL DR.
Mailing Address - Street 2:M263 MSB - DEPARTMENT OF PATHOLOGY
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212
Mailing Address - Country:US
Mailing Address - Phone:573-882-1320
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR.
Practice Address - Street 2:M263 MSB - DEPARTMENT OF PATHOLOGY
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212
Practice Address - Country:US
Practice Address - Phone:573-882-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019022190207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology