MEDICARE: DR. JONATHAN B LIGHT 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
1	207Q00000X	Family Medicine Physician	43489	AZ
2	207Q00000X	Family Medicine Physician	E-6608	AR

General Provider Information

NPI Number	:	1902009269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN B LIGHT M. D.

Provider Business Mailing Address
First Line	:	3111 W PAINTED HILLS RANCH CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-3807
Country	:	US
Telephone Number	:	520-850-7994
Fax Number	:

Provider Business Practice Location Address
First Line	:	5369 S CALLE SANTA CRUZ STE 145
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-3963
Country	:	US
Telephone Number	:	520-573-7500
Fax Number	:	520-573-7557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	11/27/2013

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