Healthcare Provider Details

I. General information

NPI: 1831449230
Provider Name (Legal Business Name): COURTNEY MARIE PRESTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CULLEN BLVD STE 108
PEARLAND TX
77584-3922
US

IV. Provider business mailing address

10907 MEMORIAL HERMANN DR STE 400
PEARLAND TX
77584-4114
US

V. Phone/Fax

Practice location:
  • Phone: 281-835-4159
  • Fax: 832-243-5423
Mailing address:
  • Phone: 281-835-4159
  • Fax: 832-243-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberP7185
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberP7185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: