Healthcare Provider Details

I. General information

NPI: 1265435788
Provider Name (Legal Business Name): LESTER DORNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 VILLAGE DR
MIDDLETOWN OH
45005
US

IV. Provider business mailing address

3290 VILLAGE DR
MIDDLETOWN OH
45005
US

V. Phone/Fax

Practice location:
  • Phone: 513-622-7703
  • Fax: 513-424-7704
Mailing address:
  • Phone: 513-622-7703
  • Fax: 513-424-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35058512D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: