=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477552669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC ROBERT MESECKE RPA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2005
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1706 MEDICAL BLVD STE 201
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-593-3500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1706 MEDICAL BLVD STE 201
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-593-3500
-----------------------------------------------------
Fax | 239-593-9163
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | PA9117376
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------