Healthcare Provider Details

I. General information

NPI: 1194949883
Provider Name (Legal Business Name): JONATHAN LIGHTFOOT BRANDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 COLE BLVD SUITE 150
LAKEWOOD CO
80401-3208
US

IV. Provider business mailing address

1746 COLE BLVD STE 150
LAKEWOOD CO
80401-3267
US

V. Phone/Fax

Practice location:
  • Phone: 303-914-8800
  • Fax: 303-716-3777
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number58835
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2013-01685
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0050215
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number50215
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number58835
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: