Active NPI
Dermatology and Skin Surgery Apmc
- Dermatology Physician
- Shreveport, LA
National Provider Identifier
1023005758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- DERMATOLOGY AND SKIN SURGERY APMC
- Practice address
- 9007 Ellerbe Rd
Shreveport, LA 71106-6724 - Phone
- (318) 222-3278
- Fax
- (318) 424-3155
- NPI assigned
- Sep 27, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jack S Resneck, MD
- Title
- President
- Phone
- (318) 222-3278
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
9007 Ellerbe Rd
Shreveport, LA 71106-6724
Mailing address
9007 Ellerbe Rd
Shreveport, LA 71106-6724
Phone (318) 222-3278
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051117000768 | LA | Part B Supplier - Clinic/Group Practice | 5294627683 |
Receives reassigned benefits from 11 practitioners Practice locations: Shreveport, LA |
National Provider Directory
National Provider DirectoryLocations
9007 Ellerbe Rd
Shreveport, LA 71106
Phone (318) 222-3278
Practitioners & affiliated clinicians
Practitioners 13
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Surgical Physician Assistant
- Shreveport, LA
- NPI 1528082781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1776816000000",
"number": "1023005758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9007 ELLERBE RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711066724",
"telephone_number": "318-222-3278",
"fax_number": "318-424-3155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9007 ELLERBE RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711066724",
"telephone_number": "318-222-3278",
"fax_number": "318-424-3155"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DERMATOLOGY AND SKIN SURGERY APMC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-27",
"last_updated": "2026-04-22",
"certification_date": "2026-04-22",
"status": "A",
"authorized_official_last_name": "RESNECK",
"authorized_official_first_name": "JACK",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "318-222-3278",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.