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General NPI Number Information
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NPI Number | 1487746236
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Entity Type | Individual
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Provider Name | MR. ROBERT DENNIS PRESTON JR.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BRACH MEDICAL CLINIC NAVAL SUPPORT ACTIVITY MID-SOUTH
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City | MILLINGTON
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State | TN
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Zip | 38054
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Country | US
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Telephone | 901-874-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 6035 SAVITZ DR
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City | MILLINGTON
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State | TN
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Zip | 38053-2729
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Country | US
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Telephone | 858-472-6169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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