Healthcare Provider Details

I. General information

NPI: 1265527717
Provider Name (Legal Business Name): PRESTON HERRINGTON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S SCHWARTZ AVE STE 102
FARMINGTON NM
87401-5925
US

IV. Provider business mailing address

PO BOX 6210
FARMINGTON NM
87499-6210
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6700
  • Fax: 505-609-6701
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-65
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: