Individual
CLINTON E PRESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 GEARY ST SE, ALBANY, OR 97322-6842
(541) 812-5500
(541) 812-5505
Mailing address
1700 GEARY ST SE, ALBANY, OR 97322-6842
(541) 812-5500
(541) 812-5505
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
6238A
WY
207P00000X
Emergency Medicine Physician
Primary
MD172857
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0057811
—
MT
01
—
080179382
RAILROAD MEDICARE
WY
05
—
114905900
—
WY
01
—
311187
BLUE CROSS BLUE SHIELD
WY
Enumeration date
10/17/2005
Last updated
08/10/2015
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