Provider Demographics
NPI:1629054531
Name:REZNICK, LISA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:REZNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 FAIRWAY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6525
Mailing Address - Country:US
Mailing Address - Phone:972-395-9000
Mailing Address - Fax:972-395-9002
Practice Address - Street 1:4100 FAIRWAY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6525
Practice Address - Country:US
Practice Address - Phone:972-395-9000
Practice Address - Fax:972-395-9002
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0169207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG01505Medicare UPIN
TX00840QMedicare PIN