| Doctor Name: | DR. MARY JO LIGHTFOOT |
| NPI Number: | 1194005058 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | UO2786 |
| Business Practice Address: | 7727 Lake Underhill Rd Orlando, FL - 328228224 |
| Business Phone Number: | 4073036413 |
| Business Fax Number: | |
| Mailing Address: | 7727 Lake Underhill Rd, ORLANDO |
| State: | FL |
| Postal Code: | 328228224 |
| Phone Number: | 4073036413 |
| Fax Number: | 4073036414 |
| NPI Enumeration Date: | 08/24/2011 |
| NPI Last Update Date: | 11/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | UO2786 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |