Provider Demographics
NPI:1417993908
Name:SPEAKMAN, PRESTON T (MD)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:T
Last Name:SPEAKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D430B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:979-393-9940
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D430B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:979-393-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL015361207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07822391Medicaid
AL51535538OtherBLUE SHIELD
AL009938316Medicaid
AL051535538Medicare PIN
E45521Medicare UPIN