Provider Demographics
NPI:1114809936
Name:SHORTRIDGE, ROGER ALAN III (PRS)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ALAN
Last Name:SHORTRIDGE
Suffix:III
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 UPSON ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-1523
Mailing Address - Country:US
Mailing Address - Phone:330-592-0245
Mailing Address - Fax:
Practice Address - Street 1:690 UPSON ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-1523
Practice Address - Country:US
Practice Address - Phone:330-592-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006675175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist