Provider Demographics
NPI:1083661052
Name:LIGHTFOOT, MEREDITH L (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:STE 434
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:214-691-1902
Practice Address - Fax:214-987-1845
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2420208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00004642OtherRRMCR OTHER
TXP00046427OtherRRMCR
TX160650101Medicaid
8K1159OtherBCBS PROVIDER ID
TX160650102Medicaid
TX8A8674Medicare PIN
8K1159OtherBCBS PROVIDER ID
TX160650102Medicaid