Healthcare Provider Details

I. General information

NPI: 1114760386
Provider Name (Legal Business Name): PRESTON HARVEY GARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NE 10TH ST
OKLAHOMA CITY OK
73104-5420
US

IV. Provider business mailing address

8400 NW 160TH CT
EDMOND OK
73013-5376
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2230
  • Fax:
Mailing address:
  • Phone: 405-542-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1145R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: