Provider Demographics
NPI:1114091410
Name:NIXON, LESTER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:JAMES
Last Name:NIXON
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 741
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-884-0999
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:420 DELAWARE STREET SE, MMC 741
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38643207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0515585Medicaid
121226OtherUCARE
WI32303000Medicaid
HP27031OtherHEALTH PARTNERS
12-00687OtherMEDICA CHOICE
MN556819600Medicaid
12-02072OtherMEDICA PRIMARY
829758OtherARAZ
50R08NIOtherBLUE CROSS BLUE SHIELD
1019181OtherPREFERRED ONE
WI32303000Medicaid
50R08NIOtherBLUE CROSS BLUE SHIELD
1019181OtherPREFERRED ONE