Provider Demographics
NPI:1760492995
Name:REZNICK, RICHARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:REZNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8573 E SAN ALBERTO DR
Mailing Address - Street 2:SUITE E-100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4383
Mailing Address - Country:US
Mailing Address - Phone:480-778-1732
Mailing Address - Fax:480-778-1709
Practice Address - Street 1:8573 E SAN ALBERTO DR
Practice Address - Street 2:SUITE E-100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4383
Practice Address - Country:US
Practice Address - Phone:480-778-1732
Practice Address - Fax:480-778-1709
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ6370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0034390OtherBCBS
AZ1Z2741OtherHEALTHNET
AZ223793OtherAHCCCS
AZ4223512OtherAETNA