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General NPI Number Information
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NPI Number | 1245477314
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Entity Type | Individual
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Provider Name | GORDON JAMES LESTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 11349 PRESERVE LN N
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City | CHAMPLIN
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State | MN
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Zip | 55316-1966
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Country | US
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Telephone | 763-323-0527
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Fax |
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Provider Business Mailing Address
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Address Line | 11349 PRESERVE LN N
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City | CHAMPLIN
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State | MN
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Zip | 55316-1966
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Country | US
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Telephone | 763-323-0527
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 18721
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License Number State | MN
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