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General NPI Number Information
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NPI Number | 1114210119
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Entity Type | Organization
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Legal Business Name | GREATER SOUTHWEST MEDICAL ASSOCIATES PA
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 815 IRA E WOODS AVENUE SUITE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-488-0100
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Fax | 817-488-4568
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Provider Business Mailing Address
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Address Line | 815 IRA E WOODS AVENUE SUITE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-488-0100
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Fax | 817-488-4568
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Authorized Official
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Title or Position | PRESIDENT AND CHIEF EXECUTIVE OFFIC
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Name | DR. RONALD A LESTER
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Credential | M.D.
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Telephone | 817-488-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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