Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 53650 | MN |
NPI | 1407060239 |
---|---|
Provider Name | Joshua J Short |
First Address | Minneapolis, MN 55404-4289 |
Second Address | Minneapolis, MN 55404-4289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 20/08/2015 |