Healthcare Provider Details

I. General information

NPI: 1932160348
Provider Name (Legal Business Name): PERVEZ A ALVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W LIBERTY ST
FARMINGTON MO
63640-1921
US

IV. Provider business mailing address

1103 W LIBERTY ST
FARMINGTON MO
63640-1921
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-6751
  • Fax:
Mailing address:
  • Phone: 573-756-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036087169
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2000166656
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: