Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | R9366 | MO |
NPI | 1013987551 |
---|---|
Provider Name | Dr. Howard Newton Short |
First Address | Washington, MO 63090-6449 |
Second Address | Washington, MO 63090-6449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B18443 | (02) | MO |