MEDICARE: GORDON CRAIG PRESTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C42783	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	C42783	CA

General Provider Information

NPI Number	:	1417940685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON CRAIG PRESTON M.D.

Provider Business Mailing Address
First Line	:	859 WASHINGTON ST # 203
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-2704
Country	:	US
Telephone Number	:	415-479-2924
Fax Number	:	949-757-2538

Provider Business Practice Location Address
First Line	:	1100 SANCHEZ ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-3825
Country	:	US
Telephone Number	:	415-479-2924
Fax Number	:	949-757-2538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	06/06/2016

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