Provider Demographics
NPI:1235175134
Name:LIGHT, JAMES MELVIN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MELVIN
Last Name:LIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2299 9TH AVE N
Mailing Address - Street 2:STE 1A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6800
Mailing Address - Country:US
Mailing Address - Phone:727-323-4458
Mailing Address - Fax:727-321-7918
Practice Address - Street 1:2299 9TH AVE N
Practice Address - Street 2:STE 1A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6800
Practice Address - Country:US
Practice Address - Phone:727-323-4458
Practice Address - Fax:727-321-7918
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0025779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058195000Medicaid
FL0025779OtherSTATE MEDICAL LICENSE
FL0025779OtherSTATE MEDICAL LICENSE
D58509Medicare UPIN