Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 130785 | NY |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 130785 | NY |
NPI | 1255398491 |
---|---|
Provider Name | Dr. Walter H Short |
First Address | Syracuse, NY 13214-1880 |
Second Address | De Witt, NY 13214-1880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B81128 | (02) |