Individual
MR. JACK S RESNECK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
845 OLIVE ST, SHREVEPORT, LA 71104
(318) 222-3278
(318) 424-3155
Mailing address
845 OLIVE ST, SHREVEPORT, LA 71104
(318) 222-3278
(318) 424-3155
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01957
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1143839
—
LA
Enumeration date
11/25/2005
Last updated
07/08/2007
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