Provider Demographics
NPI:1942229539
Name:LESTER, RONALD A (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:LESTER
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 1:1400 W NORTHWEST HWY
Mailing Address - Street 2:200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8113
Mailing Address - Country:US
Mailing Address - Phone:877-663-8522
Mailing Address - Fax:877-663-8522
Practice Address - Street 1:1400 W NORTHWEST HWY
Practice Address - Street 2:200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8113
Practice Address - Country:US
Practice Address - Phone:877-663-8522
Practice Address - Fax:877-663-8522
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155957702Medicaid
TX155957703Medicaid
TX155957703Medicaid
TX8C0195Medicare ID - Type Unspecified
TXH72570Medicare UPIN