Healthcare Provider Details

I. General information

NPI: 1942256532
Provider Name (Legal Business Name): MEZONA ORTHOPAEDIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E BANNER GATEWAY DR #200
GILBERT AZ
85234-2168
US

IV. Provider business mailing address

2940 E BANNER GATEWAY DR #200
GILBERT AZ
85234-2168
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2908
  • Fax: 480-833-2136
Mailing address:
  • Phone: 480-964-2908
  • Fax: 480-833-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: ANNETTE M PROCKNOW
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 480-964-2908