Provider Demographics
NPI:1699096479
Name:MOREHEAD, PRESTON N (MD)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:N
Last Name:MOREHEAD
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 1:497 10TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3178
Mailing Address - Country:US
Mailing Address - Phone:830-393-1363
Mailing Address - Fax:830-393-1366
Practice Address - Street 1:497 10TH ST STE 105
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3178
Practice Address - Country:US
Practice Address - Phone:830-393-1363
Practice Address - Fax:830-393-1366
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4162208600000X
TXQ4643208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery