Provider Demographics
NPI:1912948985
Name:SHORT, JASON T (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:SHORT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6614
Practice Address - Country:US
Practice Address - Phone:360-671-3345
Practice Address - Fax:360-650-1354
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-07-24
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Provider Licenses
StateLicense IDTaxonomies
WAMD00041629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA423898068OtherGROUP HEALTH COOPERATIVE
WA4253SHOtherREGENCE BLUESHIELD
WA0173144OtherLABOR & INDUSTRIES (REG)
WA8931538OtherLABOR & INDUSTRIES (CV)
WAP00064768OtherRAILROAD MEDICARE
WA8361156Medicaid
WAP00064768OtherRAILROAD MEDICARE
WAH72289Medicare UPIN