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Individual

MR. SCOTT MATTHEW LIGHT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.-C.

Contact information

Practice address
1251 NE ELM ST, SUITE 1A, PRINEVILLE, OR 97754-1206
(541) 447-1680
(541) 447-4670
Mailing address
838 ESSEX AVE, ABERDEEN, WA 98520-2718
(503) 730-6719

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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