Provider Demographics
NPI:1922148923
Name:SHORT, DOUGLAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-1669
Practice Address - Street 1:3521 HAWORTH DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7216
Practice Address - Country:US
Practice Address - Phone:919-782-1806
Practice Address - Fax:919-782-4756
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200500114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00282364OtherRAILROAD MEDICARE
2537921OtherUNITED HEALTHCARE
5036915OtherCIGNA
NC5902904Medicaid
NC1392JOtherBCBS
E3160OtherMEDCOST
E3160OtherMEDCOST
2050721Medicare PIN