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General NPI Number Information
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NPI Number | 1720060890
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Entity Type | Organization
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Legal Business Name | MESQUITE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1301 BERTHA HOWE AVE SUITE 1
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City | MESQUITE
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State | NV
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Zip | 89027-7502
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Country | US
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Telephone | 702-346-0800
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Fax | 702-346-0801
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Provider Business Mailing Address
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Address Line | 1301 BERTHA HOWE AVE SUITE 1
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City | MESQUITE
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State | NV
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Zip | 89027-7502
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Country | US
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Telephone | 702-346-0800
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Fax | 702-346-0801
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Authorized Official
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Title or Position | C.F.O.
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Name | MR. LLOYD GATHERUM
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Credential |
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Telephone | 702-346-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APN00314
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 8194
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 97
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0841
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10328
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License Number State | NV
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 10669
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License Number State | NV
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Taxonomy #7
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B355
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License Number State | NV
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