Provider Demographics
NPI:1346272671
Name:SHORT, HOPE DAUGHTREY (MD)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:DAUGHTREY
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:KATHLEEN
Other - Last Name:DAUGHTREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2756 ELKTON TRL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0723
Mailing Address - Country:US
Mailing Address - Phone:903-534-0911
Mailing Address - Fax:903-534-8882
Practice Address - Street 1:2756 ELKTON TRL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0723
Practice Address - Country:US
Practice Address - Phone:903-534-0911
Practice Address - Fax:903-534-8882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91132Medicare UPIN