Healthcare Provider Details

I. General information

NPI: 1982846317
Provider Name (Legal Business Name): BRENT KEVIN PRESLEY M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

636 ATHERTON ST
SAN MARCOS CA
92078-2802
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-2329
  • Fax:
Mailing address:
  • Phone: 214-754-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA136311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: