Healthcare Provider Details

I. General information

NPI: 1174719777
Provider Name (Legal Business Name): LAURA PRESTON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4413
US

IV. Provider business mailing address

3217 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4413
US

V. Phone/Fax

Practice location:
  • Phone: 850-942-5728
  • Fax: 850-671-4415
Mailing address:
  • Phone: 850-942-5728
  • Fax: 850-671-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME53543
License Number StateFL

VIII. Authorized Official

Name: MRS. LAURA PRESTON
Title or Position: MD
Credential: MD
Phone: 850-942-5728