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General NPI Number Information
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NPI Number | 1174719777
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Entity Type | Organization
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Legal Business Name | LAURA PRESTON MD PA
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 3217 CAPITAL MEDICAL BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4413
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Country | US
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Telephone | 850-942-5728
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Fax | 850-671-4415
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Provider Business Mailing Address
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Address Line | 3217 CAPITAL MEDICAL BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4413
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Country | US
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Telephone | 850-942-5728
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Fax | 850-671-4415
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Authorized Official
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Title or Position | MD
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Name | MRS. LAURA PRESTON
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Credential | MD
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Telephone | 850-942-5728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | ME53543
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License Number State | FL
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