Provider Demographics
NPI:1588687776
Name:SHORT, GLORI S (MD)
Entity type:Individual
Prefix:
First Name:GLORI
Middle Name:S
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 1:806 ST. VINCENT'S DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-930-1800
Mailing Address - Fax:205-930-1818
Practice Address - Street 1:806 ST. VINCENT'S DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-930-1800
Practice Address - Fax:205-930-1818
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020844207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5578454OtherAETNA
AL51035787OtherBC BS OF AL
AL160046351OtherMEDICARE SECONDARY
AL000035787Medicaid
AL7410125OtherUNITED HEALTHCARE
AL5578454OtherAETNA
AL000035787Medicare ID - Type Unspecified