Provider Demographics
NPI:1265435788
Name:DORNON, LESTER (MD)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:
Last Name:DORNON
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 1:3290 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005
Mailing Address - Country:US
Mailing Address - Phone:513-622-7703
Mailing Address - Fax:513-424-7704
Practice Address - Street 1:3290 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005
Practice Address - Country:US
Practice Address - Phone:513-622-7703
Practice Address - Fax:513-424-7704
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058512D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD5851201OtherHUMANA/CHOICECARE
OH000000246117OtherUNICARE
OH2356856Medicaid
OH35058512DOtherMEDICAL LICENSE
OH7550431OtherAETNA
OHP00004510OtherRAILROAD MEDICARE
OH108085OtherNATIONWIDE HEALTH PLAN
OH000000246117OtherANTHEM
OH452360001OtherCARESOURCE
OH35058512DOtherMEDICAL LICENSE
OH000000246117OtherUNICARE