Provider Demographics
NPI:1922369503
Name:PEZESHK, RONNIE A (MD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:A
Last Name:PEZESHK
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:UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CTR
Mailing Address - Street 2:DEPARTMENT OF PLASTIC SURGERY 1801 INWOOD ROAD
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9132
Mailing Address - Country:US
Mailing Address - Phone:214-648-8602
Mailing Address - Fax:214-648-2550
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9132
Practice Address - Country:US
Practice Address - Phone:214-645-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ26042086S0122X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery