Provider Demographics
NPI:1417955766
Name:PRESTON, MITCHELL CRAIG (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:CRAIG
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 BUTTERFIELD COACH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-9142
Mailing Address - Country:US
Mailing Address - Phone:479-757-5026
Mailing Address - Fax:479-757-5028
Practice Address - Street 1:2158 BUTTERFIELD COACH RD STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-9142
Practice Address - Country:US
Practice Address - Phone:479-757-5026
Practice Address - Fax:479-757-5028
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE11814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ821753Medicaid
AZZ78560Medicare ID - Type Unspecified
AZ821753Medicaid