Individual
DR. JOHNSON BENJAMIN LIGHTFOOTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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