Basic Information
Provider Information | |||||||||
NPI: | 1841452661 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RESCH | ||||||||
FirstName: | ALLYN | ||||||||
MiddleName: | LEIGH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4412 FOREST PARK DR | ||||||||
Address2: |   | ||||||||
City: | JACKSON | ||||||||
State: | MS | ||||||||
PostalCode: | 392116038 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6013171608 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 309 JACKSON ST | ||||||||
Address2: |   | ||||||||
City: | MONROE | ||||||||
State: | LA | ||||||||
PostalCode: | 712017407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3189664541 | ||||||||
FaxNumber: | 3189664543 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/02/2008 | ||||||||
LastUpdateDate: | 05/28/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/28/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 320976 | LA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207RP1001X | 99102347A | IN | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | 21152 | MS | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0200X | MD183692 | OR | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | T-2073 | MS | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 07550094 | 05 | MS |   | MEDICAID | 178297 | 05 | AL |   | MEDICAID |