# DR. ELIOT S LIGHT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1942382577
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | C40086 | CA | Yes |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 09/30/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00G400860 | MEDICARE PTAN | CA |
| 05 | — | 00G400860 | — | CA |
| 01 | — | 770046058 | BLUE SHIELD AND ALL OTHER | — |