Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC006625 | PA |
NPI | 1053673897 |
---|---|
Provider Name | Dr. Kevin Short |
First Address | Allentown, PA 18104-1326 |
Second Address | Allentown, PA 18104-1326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 04/05/2016 |