Provider Demographics
NPI:1265509608
Name:LESTER, ROBERT BEVERLY III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BEVERLY
Last Name:LESTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2112 CATON WAY SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1105
Mailing Address - Country:US
Mailing Address - Phone:360-754-1629
Mailing Address - Fax:360-754-1694
Practice Address - Street 1:2112 CATON WAY SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1105
Practice Address - Country:US
Practice Address - Phone:360-754-1629
Practice Address - Fax:360-754-1694
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00024617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1030576Medicaid