Provider Demographics
NPI:1730102583
Name:LESTER, ERIC JAY (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAY
Last Name:LESTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:541-984-4301
Mailing Address - Fax:
Practice Address - Street 1:2484 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2042
Practice Address - Country:US
Practice Address - Phone:541-222-7650
Practice Address - Fax:541-222-7676
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15175363AM0700X
ORPA153391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881645158OtherNPI FOR SEASIDE CLINIC
CAFHC70530FOtherMEDI-CAL GRP FQHC