Healthcare Provider Details

I. General information

NPI: 1063469880
Provider Name (Legal Business Name): WILLIAM PRESTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W COCOA BEACH CSWY CAPE CANAVERAL HOSPITAL/ANES DEPT.
COCOA BEACH FL
32931-3585
US

IV. Provider business mailing address

PO BOX 561600
ROCKLEDGE FL
32956-1600
US

V. Phone/Fax

Practice location:
  • Phone: 321-868-7677
  • Fax: 321-868-7291
Mailing address:
  • Phone: 321-434-4600
  • Fax: 321-259-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME68478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: