Individual
DR. JACK MICHAEL PRESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 DUTCH RIDGE RD, BEAVER, PA 15009-9727
(724) 773-4567
(724) 728-9729
Mailing address
3572 BRODHEAD RD, SUITE 201, MONACA, PA 15061-3101
(724) 728-6539
(724) 728-7416
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD027545E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000955474
—
PA
05
—
0009554740018
—
PA
05
—
2233292
—
OH
05
—
3810003945
—
WV
Enumeration date
01/26/2006
Last updated
04/13/2010
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