Individual
DIANE LOUISE LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5700
(573) 632-5720
Mailing address
1125 MADISON ST, PO BOX 1107, JEFFERSON CITY, MO 65101-5227
(573) 632-5700
(573) 632-5720
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
100575
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020038004
RAILROAD MEDICARE
MO
05
—
243392222
—
MO
Enumeration date
09/27/2005
Last updated
08/10/2012
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