Basic Information
| Provider Information | |||||||||
| NPI: | 1376638759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESHAN | ||||||||
| FirstName: | PRESTON | ||||||||
| MiddleName: | WARREN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4915 19TH STREET | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067915177 | ||||||||
| FaxNumber: | 8067915177 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 COLLEGE AVENUE | ||||||||
| Address2: | |||||||||
| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068944963 | ||||||||
| FaxNumber: | 8068946461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D2211 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.