Provider Demographics
NPI:1053460691
Name:SHORT, SCOTT R (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 74872
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4872
Mailing Address - Country:US
Mailing Address - Phone:419-531-3500
Mailing Address - Fax:419-531-1877
Practice Address - Street 1:3425 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1326
Practice Address - Country:US
Practice Address - Phone:419-531-3500
Practice Address - Fax:419-531-1877
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-07-8534 S2084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry