Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 59032 | TN |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 59032 | TN |
NPI | 1538505979 |
---|---|
Provider Name | Adam Tyler Short |
First Address | Knoxville, TN 37909-1293 |
Second Address | Knoxville, TN 37909-1293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 22/04/2021 |