Provider Demographics
NPI:1427053388
Name:LIGHT, MARK W (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:LIGHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1279 E 1ST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1542
Mailing Address - Country:US
Mailing Address - Phone:530-899-7300
Mailing Address - Fax:530-899-7211
Practice Address - Street 1:1279 E 1ST AVE
Practice Address - Street 2:STE C
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1542
Practice Address - Country:US
Practice Address - Phone:530-899-7300
Practice Address - Fax:530-899-7211
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG32061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G320610Medicaid
930124387OtherMEDICARE RAILROAD #
CAA44986Medicare UPIN
CA00G320610Medicare ID - Type Unspecified