Healthcare Provider Details

I. General information

NPI: 1205858230
Provider Name (Legal Business Name): PRESTON HUCKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER BLVD
ADA OK
74820
US

IV. Provider business mailing address

1921 STONECIPHER BLVD
ADA OK
74820
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-4570
  • Fax:
Mailing address:
  • Phone: 580-421-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19874
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19874
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100253710D
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer
# 2
IdentifierH37015401
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerHGH GROUP MEDICARE NUMBER
# 3
Identifier100699880C
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerRHC GROUP MEDICAID NUMBER
# 4
Identifier373994
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerGROUP RHC MEDICARE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: