Provider Demographics
NPI:1114074853
Name:PAUL G PRESTE MD & ASSOCIATES
Entity Type:Organization
Organization Name:PAUL G PRESTE MD & ASSOCIATES
Other - Org Name:PAUL G PRESTE MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRESTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-6200
Mailing Address - Street 1:3075 E COMMERCIAL BLVD
Mailing Address - Street 2:STE 1A
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3075 E COMMERCIAL BLVD
Practice Address - Street 2:STE 1A
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4311
Practice Address - Country:US
Practice Address - Phone:954-491-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38476207R00000X
FL16517207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79630Medicare ID - Type Unspecified
FLD27263Medicare UPIN