Provider Demographics
NPI:1003822016
Name:MESKO, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MESKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NORTH MORROW
Mailing Address - Street 2:SUITE A
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953
Mailing Address - Country:US
Mailing Address - Phone:479-394-4595
Mailing Address - Fax:479-394-1140
Practice Address - Street 1:403 NORTH MORROW
Practice Address - Street 2:SUITE A
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953
Practice Address - Country:US
Practice Address - Phone:479-394-4595
Practice Address - Fax:479-394-1140
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100071960 AMedicaid
AR112972001Medicaid
AR50764OtherBLUE CROSS BLUE SHEILD
AR710709244OtherTAX ID #
ARC-67911Medicare UPIN
AR710709244OtherTAX ID #