Provider Demographics
NPI:1598772402
Name:RAHMAN, PERVAIZ (MD)
Entity Type:Individual
Prefix:
First Name:PERVAIZ
Middle Name:
Last Name:RAHMAN
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 1:8078 ACOMA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-8031
Mailing Address - Country:US
Mailing Address - Phone:972-681-9800
Mailing Address - Fax:972-681-9804
Practice Address - Street 1:1 MEDICAL PKWY STE 103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7830
Practice Address - Country:US
Practice Address - Phone:972-681-9800
Practice Address - Fax:972-681-9804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7892207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0348666Medicaid
8D7760Medicare ID - Type Unspecified
B25746Medicare UPIN