Provider Demographics
NPI:1639287659
Name:PRESTON, CHARLES ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALLEN
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:985 ROBERT BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2063
Mailing Address - Country:US
Mailing Address - Phone:985-690-8300
Mailing Address - Fax:985-847-2310
Practice Address - Street 1:985 ROBERT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2063
Practice Address - Country:US
Practice Address - Phone:985-960-8300
Practice Address - Fax:985-690-8301
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA018284207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444570Medicaid
LAG5067OtherBCBS LA
LAG5067OtherBCBS LA
LA1444570Medicaid