Basic Information
| Provider Information | |||||||||
| NPI: | 1104804475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAUDHRY | ||||||||
| FirstName: | PERVAIZ | ||||||||
| MiddleName: | AKHTAR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 E RIVER PARK PL W | ||||||||
| Address2: | #260 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937201545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594411777 | ||||||||
| FaxNumber: | 5594410726 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 E RIVER PARK PL W | ||||||||
| Address2: | #260 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937201545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594411774 | ||||||||
| FaxNumber: | 5594410726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | A79662 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.