MEDICARE: MR. TERRY LEON PRESTON III

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
1	172A00000X	Driver	21005096	TX

General Provider Information

NPI Number	:	1457905838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY LEON PRESTON III

Provider Business Mailing Address
First Line	:	1931 SAXON BEND TRL
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4765
Country	:	US
Telephone Number	:	139-227-6977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 SAXON BEND TRL
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4765
Country	:	US
Telephone Number	:	139-227-6977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/24/2019

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