Provider Demographics
NPI:1609071364
Name:LIGHTFOOT, JILL L (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:L
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4700 E 56TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2904
Mailing Address - Country:US
Mailing Address - Phone:563-421-9100
Mailing Address - Fax:563-421-9129
Practice Address - Street 1:4700 E 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2904
Practice Address - Country:US
Practice Address - Phone:563-421-9100
Practice Address - Fax:563-421-9129
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8125207N00000X, 207R00000X
IA39362207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine