Provider Demographics
NPI:1619919339
Name:BANDY, PRESTON ROSS (MD)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:ROSS
Last Name:BANDY
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 1:300 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-4003
Mailing Address - Country:US
Mailing Address - Phone:501-802-0143
Mailing Address - Fax:501-622-3365
Practice Address - Street 1:300 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4003
Practice Address - Country:US
Practice Address - Phone:501-802-0143
Practice Address - Fax:501-622-3365
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3661207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112717001Medicaid
AR50657Medicare ID - Type Unspecified