Individual
SHADE RAYMOND PRESTON IV
Active
Individual
SHADE RAYMOND PRESTON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
058811
GA
207LP2900X
Pain Medicine (Anesthesiology) Physician
058811
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159750664A
—
GA
05
—
G58811
—
SC
01
—
P00424799
RAILROAD MEDICARE
GA
Enumeration date
03/29/2007
Last updated
06/16/2008
Update your record
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