Individual
TYLER J LIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
444 NW ELKS DR, CORVALLIS, OR 97330-3758
(503) 494-8311
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 754-1150
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
MD208155
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD208155
OREGON MEDICAL LICENSE
OR
Enumeration date
10/05/2016
Last updated
05/23/2022
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