Healthcare Provider Details

I. General information

NPI: 1467441048
Provider Name (Legal Business Name): CLINTON E PRESTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 GEARY ST SE
ALBANY OR
97322-6842
US

IV. Provider business mailing address

1700 GEARY ST SE
ALBANY OR
97322-6842
US

V. Phone/Fax

Practice location:
  • Phone: 541-812-5500
  • Fax: 541-812-5505
Mailing address:
  • Phone: 541-812-5500
  • Fax: 541-812-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6238A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD172857
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: