Provider Demographics
NPI:1346395803
Name:SHORT, JOANNE A (DPM)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:A
Last Name:SHORT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PMB 215
Mailing Address - Street 2:10904 SCARSDALE SUITE 350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6094
Mailing Address - Country:US
Mailing Address - Phone:281-398-0332
Mailing Address - Fax:281-398-0332
Practice Address - Street 1:10721 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034
Practice Address - Country:US
Practice Address - Phone:281-398-0332
Practice Address - Fax:281-398-0332
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX986213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DC34Medicare ID - Type Unspecified
T76579Medicare UPIN