Provider Demographics
NPI:1861451833
Name:SHORT, STEVEN R (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:SHORT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-1564
Mailing Address - Country:US
Mailing Address - Phone:785-630-2422
Mailing Address - Fax:785-630-5272
Practice Address - Street 1:609 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1564
Practice Address - Country:US
Practice Address - Phone:785-630-2422
Practice Address - Fax:785-630-5272
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0520841207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100235670DMedicaid
KS047576Medicare ID - Type Unspecified
KSG04953Medicare UPIN