Individual
AMY JO LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD.
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1511
(602) 263-1619
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29533
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
418344
—
AZ
01
—
AZ0760520
BCBSAZ
AZ
Enumeration date
11/02/2006
Last updated
07/09/2007
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