Provider Demographics
NPI:1821059569
Name:REZNIK, SCOTT IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:IRA
Last Name:REZNIK
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:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-7700
Mailing Address - Fax:214-645-2506
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-645-7700
Practice Address - Fax:214-645-2506
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2459208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S6325OtherBLUE SHIELD
TXP00269402OtherRR/MEDICARE
TX1764102-01Medicaid
TX1764102-02OtherCSHCN
TX8S6325OtherBLUE SHIELD
TXG88416Medicare UPIN