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NPI Code Detail

MEDICARE: DAVID WALKER LIGHT IV M.D.

MEDICARE: DAVID WALKER LIGHT IV M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianK9598TX

General Provider Information

NPI Number : 1346243144
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID WALKER LIGHT IV M.D.
Provider Business Mailing Address
First Line : PO BOX 4346
Second Line : DEPT 488
City : HOUSTON
State : TX
Zip : 77210-4346
Country : US
Telephone Number : 713-526-5771
Fax Number : 713-526-2036
Provider Business Practice Location Address
First Line : 12951 SOUTH FWY
Second Line :
City : HOUSTON
State : TX
Zip : 77047-1923
Country : US
Telephone Number : 713-526-5771
Fax Number : 713-526-2036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/08/2007

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