Provider Demographics
NPI:1245477314
Name:LESTER, GORDON JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:JAMES
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 1:11349 PRESERVE LN N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-1966
Mailing Address - Country:US
Mailing Address - Phone:763-323-0527
Mailing Address - Fax:
Practice Address - Street 1:11349 PRESERVE LN N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-1966
Practice Address - Country:US
Practice Address - Phone:763-323-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1245477314Medicare PIN
MNA93950Medicare UPIN