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NPI Code Detail

MEDICARE: DR. BENJAMIN DAVID LIGHTFOOT MD

MEDICARE: DR. BENJAMIN DAVID LIGHTFOOT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician80390MA

General Provider Information

NPI Number : 1497749584
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN DAVID LIGHTFOOT MD
Provider Business Mailing Address
First Line : 63 MAIN
Second Line :
City : BROCKTON
State : MA
Zip : 02301-4042
Country : US
Telephone Number : 508-559-6699
Fax Number : 508-559-1475
Provider Business Practice Location Address
First Line : 63 MAIN ST
Second Line :
City : BROCKTON
State : MA
Zip : 02301-4042
Country : US
Telephone Number : 508-559-6699
Fax Number : 508-559-1475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 07/10/2010

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