Provider Demographics
NPI:1083853832
Name:PRESTON FOREST FAMILY CLINIC, P.A.
Entity Type:Organization
Organization Name:PRESTON FOREST FAMILY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ADRIAAN C
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:214-368-6197
Mailing Address - Street 1:11661 PRESTON RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2745
Mailing Address - Country:US
Mailing Address - Phone:214-368-6197
Mailing Address - Fax:214-368-3804
Practice Address - Street 1:11661 PRESTON RD
Practice Address - Street 2:SUITE 124
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2745
Practice Address - Country:US
Practice Address - Phone:214-368-6197
Practice Address - Fax:214-368-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2537207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT808Medicare PIN