Individual
OLIVER LEE KESTERSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3100
(817) 927-3603
Mailing address
1000 HOUSTON STREET, SUITE 200, FORT WORTH, TX 76102-6415
(817) 336-0551
(888) 316-3855
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
18384
MS
207T00000X
Neurological Surgery Physician
Primary
F9664
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
646000515
TRICARE
TX
01
—
646000515
TRICARE
—
05
—
OK04289020
—
MS
Enumeration date
01/15/2007
Last updated
11/30/2021
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