Provider Demographics
NPI:1669702585
Name:DR. R. ANTON LESTER JR & ASSOCIATES
Entity type:Organization
Organization Name:DR. R. ANTON LESTER JR & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:903-592-8101
Mailing Address - Street 1:214 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8136
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7322207R00000X
TX607316363LP0200X
TX681561363LF0000X
TXF3204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX420343501375OtherICS
TX218401201Medicaid
TX218401202Medicaid
TX1751398494967001OtherTX REHAB
TXZNHW317OtherIACS
TX420343501375OtherICS
TX218401202Medicaid