Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD25560 | DC |
N | 208200000X | Surgeon | MD25560 | DC |
N | 208600000X | Surgeon | MD25560 | DC |
NPI | 1376513176 |
---|---|
Provider Name | Dr. Jimmy Light |
First Address | Chevy Chase, MD 20815-5218 |
Second Address | Washington, DC 20010-2976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 27/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007305818 | (05) | DC |
025597100 | (05) | DC |
327801200 | (05) | DC |
C88967 | (02) | DC |