Provider Demographics
NPI:1316171325
Name:SHORT, ROBERTSON J II (AP, DOM)
Entity type:Individual
Prefix:DR
First Name:ROBERTSON
Middle Name:J
Last Name:SHORT
Suffix:II
Gender:M
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 POMELO DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2716
Mailing Address - Country:US
Mailing Address - Phone:941-493-8596
Mailing Address - Fax:
Practice Address - Street 1:2846 POPLAR ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7322
Practice Address - Country:US
Practice Address - Phone:941-993-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2687171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist