Provider Demographics
NPI:1174803118
Name:MEZERA, TONY JAMES (PA-C)
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:JAMES
Last Name:MEZERA
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2153 VALLEYGATE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3681
Mailing Address - Country:US
Mailing Address - Phone:910-321-7246
Mailing Address - Fax:910-321-7245
Practice Address - Street 1:2153 VALLEYGATE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3681
Practice Address - Country:US
Practice Address - Phone:910-321-7246
Practice Address - Fax:910-321-7245
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2014-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC001002732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical