Provider Demographics
NPI:1942256532
Name:MEZONA ORTHOPAEDIC, P.A.
Entity Type:Organization
Organization Name:MEZONA ORTHOPAEDIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PROCKNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-964-2908
Mailing Address - Street 1:2940 E BANNER GATEWAY DR
Mailing Address - Street 2:#200
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2168
Mailing Address - Country:US
Mailing Address - Phone:480-964-2908
Mailing Address - Fax:480-833-2136
Practice Address - Street 1:2940 E BANNER GATEWAY DR
Practice Address - Street 2:#200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2168
Practice Address - Country:US
Practice Address - Phone:480-964-2908
Practice Address - Fax:480-833-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty