MEDICARE: MESQUITE MEDICAL ASSOCIATES

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	APN00314	NV
2	207Q00000X	Family Medicine Physician	8194	NV
3	207Q00000X	Family Medicine Physician	97	NV
4	207R00000X	Internal Medicine Physician	0841	NV
5	207R00000X	Internal Medicine Physician	10328	NV
6	208000000X	Pediatrics Physician	10669	NV
7	111N00000X	Chiropractor	B355	NV

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PIN#38138	OTHER	NV	LEO BLACK, DC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PIN#37972	OTHER	NV	ENRIQUE ALFARO, MD
4	PIN#32238	OTHER	NV	LONNIE EMPEY, DO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	PIN#36266	OTHER	NV	JEFFREY WRIGHT, PAC

NPI Number	:	1720060890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESQUITE MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1301 BERTHA HOWE AVE
Second Line	:	SUITE 1
City	:	MESQUITE
State	:	NV
Zip	:	89027-7502
Country	:	US
Telephone Number	:	702-346-0800
Fax Number	:	702-346-0801

Provider Business Practice Location Address
First Line	:	1301 BERTHA HOWE AVE
Second Line	:	SUITE 1
City	:	MESQUITE
State	:	NV
Zip	:	89027-7502
Country	:	US
Telephone Number	:	702-346-0800
Fax Number	:	702-346-0801

Authorized Official
Title or Position	:	C.F.O.
Name	:	MR. LLOYD GATHERUM
Credential	:
Telephone Number	:	702-346-0800

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	09/11/2025