Provider Demographics
NPI:1053179242
Name:LESTER, LAMARCO TERRON
Entity type:Individual
Prefix:
First Name:LAMARCO
Middle Name:TERRON
Last Name:LESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481037
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74148-1037
Mailing Address - Country:US
Mailing Address - Phone:918-346-1852
Mailing Address - Fax:
Practice Address - Street 1:3932 E 2ND PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-1216
Practice Address - Country:US
Practice Address - Phone:918-346-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine