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NPI Code Detail

MEDICARE: MARK PAUL PRESTON M.D., J.D.

MEDICARE: MARK PAUL PRESTON M.D., J.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician172699-01NY
22085R0202XDiagnostic Radiology PhysicianME72678FL

General Provider Information

NPI Number : 1396729810
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK PAUL PRESTON M.D., J.D.
Provider Business Mailing Address
First Line : 122 4TH AVE
Second Line : SUITE 100
City : INDIALANTIC
State : FL
Zip : 32903-3112
Country : US
Telephone Number : 321-409-0667
Fax Number : 321-409-0668
Provider Business Practice Location Address
First Line : 122 4TH AVE
Second Line : SUITE 100
City : INDIALANTIC
State : FL
Zip : 32903-3112
Country : US
Telephone Number : 321-409-0667
Fax Number : 321-409-0668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 02/05/2024

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