Individual
DR. JOHNSON BENJAMIN LIGHTFOOTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1798 N GAREY AVE, POMONA, CA 91767
(909) 865-9535
(909) 630-7394
Mailing address
808 S EASTHILLS DR, WEST COVINA, CA 91791-3449
(909) 865-9535
(909) 630-7394
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
G39456
CA
2085R0202X
Diagnostic Radiology Physician
Primary
G39456
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200500078
STATE MEDICAL LICENSE
NC
01
—
AL 8043
STATE MEDICAL LICENSE
AL
01
—
G39456
STATE MEDICAL LICENSE
CA
01
—
ME 90724
STATE MEDICAL LICENSE
FL
Enumeration date
11/18/2005
Last updated
06/11/2011
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