Provider Demographics
NPI:1366455354
Name:RESNICK, HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:
Last Name:RESNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OAK DR SOUTH
Mailing Address - Street 2:#107
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5626
Mailing Address - Country:US
Mailing Address - Phone:979-297-0028
Mailing Address - Fax:979-297-0504
Practice Address - Street 1:201 OAK DR SOUTH
Practice Address - Street 2:#107
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5626
Practice Address - Country:US
Practice Address - Phone:979-297-0028
Practice Address - Fax:979-297-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082258701Medicaid
TX741649666OtherTAX ID #
TXC06864Medicare UPIN
TX8L21161Medicare PIN