Provider Demographics
NPI:1386692614
Name:SHORT, MICHAEL CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3417 GASTON AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2031
Mailing Address - Country:US
Mailing Address - Phone:972-993-5000
Mailing Address - Fax:972-993-5001
Practice Address - Street 1:4708 DEXTER DR STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5571
Practice Address - Country:US
Practice Address - Phone:972-993-5050
Practice Address - Fax:972-993-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2024-03-06
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Provider Licenses
StateLicense IDTaxonomies
TXL7286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH96382Medicare UPIN