Individual
DR. JACKIE LYNN PRESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 E HARRIS AVE, SAN ANGELO, TX 76903-5904
(325) 653-6741
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H4758
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133739610
—
TX
01
—
8R7522
BCBS
TX
Enumeration date
05/31/2005
Last updated
12/19/2012
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