Provider Demographics
NPI:1801807649
Name:PRESTON, JOSEPH KEITH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KEITH
Last Name:PRESTON
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 1:4015 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5212
Mailing Address - Country:US
Mailing Address - Phone:903-784-7959
Mailing Address - Fax:903-784-7969
Practice Address - Street 1:4015 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5212
Practice Address - Country:US
Practice Address - Phone:903-784-7959
Practice Address - Fax:903-784-7969
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5880207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156446002Medicaid
TX156446002Medicaid
TXG36738Medicare UPIN
TXTXB116422Medicare PIN
TX156446002Medicaid