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Individual
MR. SCOTT MATTHEW LIGHT
Active
Individual
MR. SCOTT MATTHEW LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA01153
OR
363AM0700X
Medical Physician Assistant
Primary
PA10005254
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213187
—
OR
01
—
PA01153
OREGON STATE LICENSE
OR
01
—
PA10005254
WA LICENCE
WA
Enumeration date
10/16/2006
Last updated
02/23/2012
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