Provider Demographics
NPI:1992771174
Name:SHORTS, STEPHEN DONALD (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DONALD
Last Name:SHORTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7008
Mailing Address - Country:US
Mailing Address - Phone:870-535-5719
Mailing Address - Fax:870-536-1963
Practice Address - Street 1:1722 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7008
Practice Address - Country:US
Practice Address - Phone:870-535-5719
Practice Address - Fax:870-536-1963
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3276207Y00000X, 231H00000X, 207K00000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103062001Medicaid
AR54826OtherARKANSAS BLUE CROSS BLUE SHIELD
AR548266924Medicare PIN
AR54826Medicare PIN
ARD09007Medicare UPIN