Provider Demographics
NPI:1679512933
Name:SHORT, TIMOTHY J (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:SHORT
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-319-3283
Mailing Address - Fax:520-319-3982
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:#251-C
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-319-3283
Practice Address - Fax:520-319-3982
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ647213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V08236Medicare UPIN