Provider Demographics
NPI:1902009269
Name:LIGHT, JONATHAN B (M D)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:LIGHT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 W PAINTED HILLS RANCH CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-3807
Mailing Address - Country:US
Mailing Address - Phone:520-850-7994
Mailing Address - Fax:
Practice Address - Street 1:5369 S CALLE SANTA CRUZ STE 145
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-3963
Practice Address - Country:US
Practice Address - Phone:520-573-7500
Practice Address - Fax:520-573-7557
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43489207Q00000X
ARE-6608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine