Provider Demographics
NPI:1316989205
Name:RESNEDER, JOHN RAY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAY
Last Name:RESNEDER
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 1:900 N PORTER AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6424
Mailing Address - Country:US
Mailing Address - Phone:405-366-8900
Mailing Address - Fax:405-366-8903
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6424
Practice Address - Country:US
Practice Address - Phone:405-366-8900
Practice Address - Fax:405-366-8903
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100950AMedicaid
OK1770751299OtherNPI GROUP
OK1770751299OtherNPI GROUP
OK1770751299OtherNPI GROUP