| Doctor Name: | DR. JOHN LICHTENBERGER |
| NPI Number: | 1215098504 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 101 Bodin Cir David Grant Medical Center, Department Of Radiology Travis Afb, CA - 945351809 |
| Business Phone Number: | 7074235230 |
| Business Fax Number: | |
| Mailing Address: | 10470 Old Placerville Rd, Suite 100 SACRAMENTO |
| State: | CA |
| Postal Code: | 958272539 |
| Phone Number: | 8004700071 |
| Fax Number: | |
| NPI Enumeration Date: | 12/12/2006 |
| NPI Last Update Date: | 07/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |