Provider Demographics
NPI:1194796243
Name:PRESTON, GLENN GEOFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:GEOFFREY
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:ABBEN CANCER CENTER
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4330
Mailing Address - Country:US
Mailing Address - Phone:712-264-6550
Mailing Address - Fax:712-264-6553
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:ABBEN CANCER CENTER
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4330
Practice Address - Country:US
Practice Address - Phone:712-264-6550
Practice Address - Fax:712-264-6553
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA40571207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7129775OtherAETNA HMO
TXP000321077OtherRAILROAD MEDICARE
TX181115001Medicaid
TX8S2183OtherBLUECROSS/BLUESHIELD TX.
TX181115001Medicaid
I53210Medicare UPIN