Individual
JEFFREY I RESNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 BEARD CREEK RD, EDWARDS, CO 81632
(970) 569-7656
(970) 569-7657
Mailing address
PO BOX 848997, BOSTON, MA 02284-8997
(970) 569-7656
(970) 569-7657
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G60190
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G601900
BLUE SHIELD PIN
CA
05
—
00G601900
—
CA
01
—
240007817
MEDICARE RAILROAD PIN
CA
Enumeration date
07/03/2006
Last updated
07/27/2009
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