Provider Demographics
NPI:1205316585
Name:SPECIALITY AT PAUL G. PRESTE MD & ASSOCIATES, LLC
Entity type:Organization
Organization Name:SPECIALITY AT PAUL G. PRESTE MD & ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-491-6200
Mailing Address - Street 1:3075 E COMMERCIAL BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4318
Mailing Address - Country:US
Mailing Address - Phone:954-491-6200
Mailing Address - Fax:954-491-6419
Practice Address - Street 1:3075 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-491-6200
Practice Address - Fax:954-491-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134189207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6RRBOtherFLORIDA BLUE PROVIDER ID