Provider Demographics
NPI:1538505979
Name:SHORT, ADAM TYLER (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TYLER
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1293
Mailing Address - Country:US
Mailing Address - Phone:865-558-4400
Mailing Address - Fax:865-558-4421
Practice Address - Street 1:1422 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1293
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-558-4421
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59032207XX0004X, 207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program