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Individual
MR. GREGORY ROBERT MESA
Active
Individual
MR. GREGORY ROBERT MESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
103090
NC
363A00000X
Physician Assistant
Primary
5442
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103090
STATE LICENSE NUMBER
NC
01
—
147223XX
PREFERRED CARE
—
01
—
267311481
CHAMPUS
—
05
—
348944A
—
NC
05
—
348944C
—
NC
01
—
5442
STATE LICENSE NUMBER
SC
01
—
550847506
SE MEDICARE COMPLETE
—
05
—
8913525
—
NC
01
—
D1819
MEDCOST PREFERRED
—
01
—
DB5806
RAILROAD
—
01
—
P00163937
RAILROAD
—
01
—
P61859
HUMA HUMANA
—
Enumeration date
02/26/2007
Last updated
08/10/2026
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