Provider Demographics
NPI:1306882501
Name:ALEXANDER, LESTER TRULIE (MD)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:TRULIE
Last Name:ALEXANDER
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 1:4747 DUSTY LAKE DR STE G1
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-9056
Mailing Address - Country:US
Mailing Address - Phone:870-536-6600
Mailing Address - Fax:870-534-1519
Practice Address - Street 1:4747 DUSTY LAKE DR STE G1
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-9056
Practice Address - Country:US
Practice Address - Phone:870-536-6600
Practice Address - Fax:870-534-1519
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50074OtherBCBS
ARD16966Medicare UPIN
50074Medicare ID - Type Unspecified