Healthcare Provider Details

I. General information

NPI: 1720060890
Provider Name (Legal Business Name): MESQUITE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BERTHA HOWE AVE SUITE 1
MESQUITE NV
89027-7502
US

IV. Provider business mailing address

1301 BERTHA HOWE AVE SUITE 1
MESQUITE NV
89027-7502
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-0800
  • Fax: 702-346-0801
Mailing address:
  • Phone: 702-346-0800
  • Fax: 702-346-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN00314
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8194
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0841
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10328
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10669
License Number StateNV
# 7
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB355
License Number StateNV

VIII. Authorized Official

Name: MR. LLOYD GATHERUM
Title or Position: C.F.O.
Credential:
Phone: 702-346-0800