Provider Demographics
NPI:1932214848
Name:DR. LEE R. LIGHT M.D.
Entity Type:Organization
Organization Name:DR. LEE R. LIGHT M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-262-1833
Mailing Address - Street 1:850 CENTRAL AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6021
Mailing Address - Country:US
Mailing Address - Phone:239-262-1833
Mailing Address - Fax:239-262-3097
Practice Address - Street 1:850 CENTRAL AVE STE 301
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6021
Practice Address - Country:US
Practice Address - Phone:239-262-1833
Practice Address - Fax:239-262-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL6834825OtherDEA
FL=========OtherTAX ID
FLD57998Medicare UPIN
FL=========OtherTAX ID