MR. JACK S RESNECK (NPI# 1861475691) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861475691 |
| Entity Type | Individual |
| Full Name | MR. JACK S RESNECK |
| Credential | MD |
| Practice Address |
845 Olive St Shreveport LA 71104 |
| Practice Telephone | 3182223278 |
| Practice Fax Number | 3184243155 |
| Mailing Telephone | 3182223278 |
| Mailing Fax Number | 3184243155 |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 01957 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1143839 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760449292 | Jack S Resneck Jr. | Dermatology | 1701 Divisadero St, 4th Floor Dermatology Faculty Practice, San Francisco, CA 94143-0316 | 2006-04-27 |
| Street Address |
845 OLIVE ST |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548243793 | Donald I Posner | Dermatology | 845 Olive St, Shreveport, LA 71104-2101 | 2005-11-22 |
| 1063769255 | Wk Tots To Teens Pediatric Center | Pediatrics | 845 Olive St, Suite A, Shreveport, LA 71104-2141 | 2012-08-07 |
| 1306100029 | Ramona Dsouza | Pediatrics | 845 Olive St, Suite A, Shreveport, LA 71104-2141 | 2012-06-27 |
| 1427291863 | Stacey D Sparks | Pediatrics | 845 Olive St, Shreveport, LA 71104-2141 | 2009-04-15 |
| 1932310687 | Sheyenne W Carper | Pediatrics | 845 Olive St, Suite A, Shreveport, LA 71104-2141 | 2007-05-24 |
| 1851358998 | Jason Jude Romero | Dermatology | 845 Olive St, Shreveport, LA 71104-2101 | 2006-05-01 |
| 1306829916 | David J Clemons | Dermatology | 845 Olive St, Shreveport, LA 71104-2101 | 2005-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326582263 | Dana Jackson | Counselor | 2425 Youree Drive, Shreveport, LA 71104 | 2016-12-12 |
| 1154772929 | Belena Cawthorne | Case Manager/Care Coordinator | 2040 Southern Ave, Shreveport, LA 71104 | 2016-06-23 |
| 1437505286 | Courtney Espenan | Counselor | 3825 Gilbert Dr Ste 124, Shreveport, LA 71104 | 2016-05-11 |
| 1215390497 | Joshua Mitchell | Counselor | 1106 Dalzell Street, Shreveport, LA 71104 | 2016-04-04 |
| 1699135426 | Amy Lutricia Krohn | Counselor | 1041 Dalzell St, Shreveport, LA 71104 | 2016-03-07 |
| 1225497779 | Annie Redding II | Counselor | 2525 Youree Dr Suite 110, Shreveport, LA 71104 | 2016-02-12 |
| 1891152328 | Council On Alcoholism and Drug Abuse of Northwest Louisiana | Community/Behavioral Health | 2000 Fairfield Ave, Shreveport, LA 71104 | 2016-01-28 |
| 1922465731 | Marteze Singleton | Case Manager/Care Coordinator | 2525 Youree Dr Ste 10, Shreveport, LA 71104 | 2016-01-25 |
| 1891160297 | Damara Mora | Counselor | 2620 Centenary Blvd Bldg3 Ste 312, Shreveport, LA 71104 | 2015-12-10 |
| 1962876250 | Chastity Shermaine Graham | Counselor | 2620 Centenary Blvd Ste 312, Shreveport, LA 71104 | 2015-11-24 |
| Find all providers in zip 71104 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194936849 | Steven Cooper Heard | Dermatology | 9007 Ellerbe Rd., Shreveport, LA 71106 | 2007-05-24 |
| 1548243793 | Donald I Posner | Dermatology | 845 Olive St, Shreveport, LA 71104-2101 | 2005-11-22 |
| 1023005758 | Dermatology and Skin Surgery Apmc | Dermatology | 9007 Ellerbe Rd, Shreveport, LA 71106-6724 | 2005-09-27 |
| 1568464980 | Paul Ratcliff Winder | Dermatology | 742 Pierremont Rd, Shreveport, LA 71106-2212 | 2005-08-15 |
| 1588806970 | Wk North Dermatology Clinic | Dermatology | 2751 Albert L Bicknell Dr, Suite 2-d, Shreveport, LA 71103-3920 | 2009-03-31 |
| 1730335753 | Sarah Grace Baker | Dermatology | 2751 Albert L Bicknell Dr, Suite 2-d, Shreveport, LA 71103-3920 | 2008-08-10 |
| 1881854883 | Elizabeth L Clemons | Dermatology | 9007 Ellerbe Rd, Shreveport, LA 71106-6724 | 2008-06-12 |
| 1881889079 | Winder-turk-jones Dermatology Apc | Dermatology | 742 Pierremont Rd, Shreveport, LA 71106-2212 | 2007-09-11 |
| 1699711978 | Patrick Richard Carrington | Dermatology | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2006-06-22 |
| 1679517148 | Laura Sherrod Haynie | Dermatology | 2751 Albert L Bicknell Dr, Suite 2-d, Shreveport, LA 71103-3920 | 2006-06-15 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.