Provider Demographics
NPI:1285605758
Name:SHORT, PATRICIA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROS CIR
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-5002
Mailing Address - Country:US
Mailing Address - Phone:509-775-3153
Mailing Address - Fax:509-775-8929
Practice Address - Street 1:10 ROS CIR
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5002
Practice Address - Country:US
Practice Address - Phone:509-775-3153
Practice Address - Fax:509-775-8929
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine