Individual
DR. BENJAMIN W LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
Contact information
Practice address
1218 13TH AVE SE, DECATUR, AL 35601-4307
(256) 355-6200
(256) 355-6241
Mailing address
1218 13TH AVE SE, DECATUR, AL 35601-4307
(256) 355-6200
(256) 355-6241
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
00024976
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051512384
PROVIDER NUMBER
AL
05
—
051512384
—
AL
01
—
515-12384
BCBS
AL
01
—
CM6320
RAILROAD MEDICARE
AL
01
—
P00017388
RAILROAD MEDICARE
AL
Enumeration date
11/08/2005
Last updated
01/28/2013
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