Provider Demographics
NPI:1417010331
Name:REESE, LESTER THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:THOMAS
Last Name:REESE
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 1:522 NORTH NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-567-5873
Mailing Address - Fax:314-567-4040
Practice Address - Street 1:522 NORTH NEW BALLAS ROAD
Practice Address - Street 2:SUITE 316
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-567-5873
Practice Address - Fax:314-567-4040
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3735207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10806Medicare UPIN