Provider Demographics
NPI:1801814199
Name:PERVIER, KENNETH RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RAYMOND
Last Name:PERVIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:SUITE C-310
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-276-0222
Mailing Address - Fax:907-276-0266
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE C-310
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-276-0222
Practice Address - Fax:907-276-0266
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK20642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD20644Medicaid
AKMD20644Medicaid
C97206Medicare UPIN