Provider Demographics
NPI:1487765293
Name:SHORT, WILLIAM JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
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 1:200 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7018
Mailing Address - Country:US
Mailing Address - Phone:606-324-7083
Mailing Address - Fax:606-324-9414
Practice Address - Street 1:200 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7018
Practice Address - Country:US
Practice Address - Phone:606-324-7083
Practice Address - Fax:606-324-9414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY29564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64295645Medicaid
F61098Medicare UPIN
KY64295645Medicaid