Provider Demographics
NPI:1740275270
Name:LESTER, R ANTON III (DO)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:ANTON
Last Name:LESTER
Suffix:III
Gender:M
Credentials:DO
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 6808
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6808
Mailing Address - Country:US
Mailing Address - Phone:903-592-8101
Mailing Address - Fax:903-526-0565
Practice Address - Street 1:214 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8136
Practice Address - Country:US
Practice Address - Phone:903-592-8101
Practice Address - Fax:903-526-0565
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121073404Medicaid
TX420343501375OtherICS
TX121073401Medicaid
TX420343501375OtherICS
TXTXB102842Medicare PIN
TX121073404Medicaid