MEDICARE: DR. COURTNEY MARIE PRESTON MD

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	2084N0600X	Clinical Neurophysiology Physician	P7185	TX
2	2084N0400X	Neurology Physician	P7185	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00106W	OTHER	TX	MEDICARE HARRIS COUNTY GRP PTAN
3	D6392	OTHER		RR MEDICARE GRP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0035TD	OTHER	TX	BCBSTX GRP PROVIDER RECORD #

General Provider Information

NPI Number	:	1831449230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY MARIE PRESTON MD

Provider Business Mailing Address
First Line	:	10907 MEMORIAL HERMANN DR STE 400
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-4114
Country	:	US
Telephone Number	:	281-835-4159
Fax Number	:	832-243-5423

Provider Business Practice Location Address
First Line	:	2950 CULLEN BLVD STE 108
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-3922
Country	:	US
Telephone Number	:	281-835-4159
Fax Number	:	832-243-5423

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

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	12/30/2022

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Directions to “ DR. COURTNEY MARIE PRESTON MD” Practice Location

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