Provider Demographics
NPI:1144277054
Name:LIGHTFOOT, ROBERT KIRKLAND (MS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KIRKLAND
Last Name:LIGHTFOOT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AUDIOLOGY SECTION, VAMC
Mailing Address - Street 2:700 SO. 19TH STREET
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233
Mailing Address - Country:US
Mailing Address - Phone:205-558-4704
Mailing Address - Fax:
Practice Address - Street 1:700 19TH ST S
Practice Address - Street 2:AUDIOLOGY SECTION, VAMC
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1927
Practice Address - Country:US
Practice Address - Phone:205-558-4704
Practice Address - Fax:205-933-4464
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL838A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL838AOtherSTATE LICENSE