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General NPI Number Information
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NPI Number | 1508891078
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Entity Type | Individual
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Provider Name | JEFFREY RICHARDSON PRESTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 1201 E 3RD ST LOWER LEVEL
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City | CASPER
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State | WY
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Zip | 82601-2932
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Country | US
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Telephone | 307-577-2195
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Fax | 307-577-2968
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Provider Business Mailing Address
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Address Line | 1201 E 3RD ST LOWER LEVEL
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City | CASPER
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State | WY
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Zip | 82601-2932
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Country | US
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Telephone | 307-577-2195
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Fax | 307-577-2968
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 43917
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TL2895
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License Number State | WY
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