Provider Demographics
NPI:1104930981
Name:BLUTH, LESTER I (MD)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:I
Last Name:BLUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-479-3561
Mailing Address - Fax:
Practice Address - Street 1:4235 SECOR ROAD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-479-5650
Practice Address - Fax:419-479-3982
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 046748174400000X
OH35046748207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC03285Medicare UPIN
OHH108883Medicare PIN
OH0607434Medicare PIN