Provider Demographics
NPI:1922128719
Name:JAMES B PRESTON, DPM INC
Entity Type:Organization
Organization Name:JAMES B PRESTON, DPM INC
Other - Org Name:JAMES B PRESTON DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-855-1333
Mailing Address - Street 1:465 VIEW LN
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-5537
Mailing Address - Country:US
Mailing Address - Phone:949-855-1333
Mailing Address - Fax:435-783-9286
Practice Address - Street 1:465 VIEW LN
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-5537
Practice Address - Country:US
Practice Address - Phone:949-855-1333
Practice Address - Fax:435-783-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2494213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2494Medicare ID - Type Unspecified