Provider Demographics
NPI:1205058690
Name:PERVAIZ, MOHAMMAD HASSAN (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:HASSAN
Last Name:PERVAIZ
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 1:8440 WALNUT HILL LN STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3879
Mailing Address - Country:US
Mailing Address - Phone:214-369-3613
Mailing Address - Fax:
Practice Address - Street 1:8440 WALNUT HILL LN STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3879
Practice Address - Country:US
Practice Address - Phone:214-369-3613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24517207RC0000X
TXS3733207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0073015000Medicaid
FLKP245OtherFL MEDICARE
FL101652300Medicaid