Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 02001212A | IN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 02001212A | IN |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 02001212A | IN |
NPI | 1134184153 |
---|---|
Provider Name | David George Short |
First Address | Logansport, IN 46947-1594 |
Second Address | Logansport, IN 46947-1594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 08/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000090844 | ANTHEM (01) | IN |
000000596741 | ANTHEM (LMH) (01) | IN |
0004358987 | AETNA (01) | IN |
100071010 | (05) | IN |
1019948 | TRICARE (01) | IN |
265973 | HARMONY (01) | IN |
356001853017 | TRICARE (01) | IN |
5231880002 | CIGNA (01) | IN |
B48469 | (02) | IN |