Provider Demographics
NPI:1962480475
Name:MESA, RUBEN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:ANTHONY
Last Name:MESA
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR
Practice Address - Street 2:STE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2990
Practice Address - Country:US
Practice Address - Phone:980-442-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00022207RH0003X, 207RX0202X, 207RH0000X
AZ41843207RH0003X
MN38863207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN967717800Medicaid
AZP00804326OtherRAILROAD MEDICARE
TX375698301Medicaid
TX375698302OtherCSHCN
AZ427785Medicaid
TX375698302OtherCSHCN
MN830000296Medicare ID - Type Unspecified
MN110165409Medicare ID - Type UnspecifiedRAILROAD
AZ427785Medicaid