Provider Demographics
NPI:1215918842
Name:PEVERALL, ELIZABETH MORRIS (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MORRIS
Last Name:PEVERALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SEVEN MILE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-8509
Mailing Address - Country:US
Mailing Address - Phone:828-675-4116
Mailing Address - Fax:828-675-9312
Practice Address - Street 1:116 SEVEN MILE RIDGE RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-8509
Practice Address - Country:US
Practice Address - Phone:828-675-4116
Practice Address - Fax:828-675-9312
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500689207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8966862Medicaid
NC8966862Medicaid
NC2230425AMedicare ID - Type Unspecified