Individual
DR. JACK MICHAEL PRESTON
Active
Individual
DR. JACK MICHAEL PRESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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