Basic Information
| Provider Information | |||||||||
| NPI: | 1306882501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | LESTER | ||||||||
| MiddleName: | TRULIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4747 DUSTY LAKE DR STE G1 | ||||||||
| Address2: | |||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716039056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705366600 | ||||||||
| FaxNumber: | 8705341519 | ||||||||
| Practice Location | |||||||||
| Address1: | 4747 DUSTY LAKE DR STE G1 | ||||||||
| Address2: | |||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716039056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705366600 | ||||||||
| FaxNumber: | 8705341519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C5865 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50074 | 01 | AR | BCBS | OTHER |