Individual
PRESTON WILSON ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
52 W UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 842-8475
Mailing address
52 W UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 842-8475
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME153080
FL
208D00000X
General Practice Physician
25884
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114399900
—
FL
01
—
PK946
MEDICARE PTAN OHRI
FL
01
—
PS474
MEDICARE PTAN OHMG
FL
01
—
XB1XY
BCBS
FL
Enumeration date
04/26/2009
Last updated
03/28/2023
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