Provider Demographics
NPI:1376739631
Name:SMITH, BENJAMIN LIGHTFOOT (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LIGHTFOOT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BURNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2904
Mailing Address - Country:US
Mailing Address - Phone:215-584-5780
Mailing Address - Fax:
Practice Address - Street 1:302 BURNSIDE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2904
Practice Address - Country:US
Practice Address - Phone:215-584-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics