=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134121999
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PERVEZ MUSSARAT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2005
-----------------------------------------------------
Last Update Date | 02/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15784 MEDICAL ARTS DR SUITE A
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-1446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-542-9441
-----------------------------------------------------
Fax | 985-542-9414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15784 MEDICAL ARTS DR SUITE A
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-1446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-542-9441
-----------------------------------------------------
Fax | 985-542-9414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 08635R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------