Provider Demographics
NPI:1932289402
Name:LIGHTFOOT, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:LIGHTFOOT
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:PO BOX 10583
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-0583
Mailing Address - Country:US
Mailing Address - Phone:251-435-5711
Mailing Address - Fax:251-435-6478
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-5711
Practice Address - Fax:251-435-6478
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.12742207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-33151OtherBCBS
AL009925315Medicaid
AL515-33150OtherBCBS
AL009936274Medicaid
AL515-16635OtherBCBS
AK1932289402OtherTRICARE SOUTH
AL009936272Medicaid
AL009936273Medicaid
AL510-03435OtherBCBS
AL009925315Medicaid
AK1932289402OtherTRICARE SOUTH
AL515-33150OtherBCBS