Healthcare Provider Details

I. General information

NPI: 1396709903
Provider Name (Legal Business Name): WILLIAM PRESTON MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N 400 W SUITE B6
OREM UT
84057-1909
US

IV. Provider business mailing address

155 N 400 W SUITE B6
OREM UT
84057-1909
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-1300
  • Fax: 801-225-3236
Mailing address:
  • Phone: 801-224-1300
  • Fax: 801-225-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number163269-1205
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier528276421000
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: DR. WILLIAM D. PRESTON II
Title or Position: PRESIDENT
Credential: M.D.
Phone: 801-224-1300