Provider Demographics
NPI:1215931837
Name:SHORT, JAMES WINN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WINN
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 DOCTORS CT
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4571
Mailing Address - Country:US
Mailing Address - Phone:336-598-0002
Mailing Address - Fax:336-599-2159
Practice Address - Street 1:796 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4571
Practice Address - Country:US
Practice Address - Phone:336-598-0002
Practice Address - Fax:336-599-2159
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34464174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7975984Medicaid
NCG06446Medicare UPIN
NC2211688BMedicare PIN