Provider Demographics
NPI:1568733251
Name:LESTER B COLLINS III MD PC
Entity Type:Organization
Organization Name:LESTER B COLLINS III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:903-595-2643
Mailing Address - Street 1:PO BOX 132419
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-2419
Mailing Address - Country:US
Mailing Address - Phone:903-595-2643
Mailing Address - Fax:903-595-6816
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE 910
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-595-2643
Practice Address - Fax:903-595-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE42632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120213702Medicaid
TX00AR27Medicare PIN
TX120213702Medicaid