Provider Demographics
NPI:1134225550
Name:PRESTON, EUGENE A (PA-C)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:A
Last Name:PRESTON
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:17511 HEPLER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1831
Mailing Address - Country:US
Mailing Address - Phone:574-276-6248
Mailing Address - Fax:269-428-2943
Practice Address - Street 1:3800 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8510
Practice Address - Country:US
Practice Address - Phone:269-428-2552
Practice Address - Fax:269-428-2943
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-03-23
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Provider Licenses
StateLicense IDTaxonomies
MI5601002633363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical