Provider Demographics
NPI:1942270772
Name:SHORT, PATRICIA D (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:SHORT
Suffix:
Gender:F
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:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:504 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:409-539-1111
Practice Address - Fax:409-788-8044
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2647207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150791503Medicaid
TX8F9646OtherBC/BS PROVIDER NUMBER
TX1942270772OtherTRICARE SOUTH
TX150791502Medicaid
TXP00127404Medicare PIN
TX1942270772OtherTRICARE SOUTH
TX8L14675Medicare PIN
TX8F9646OtherBC/BS PROVIDER NUMBER
TXTXB126504Medicare PIN
TX323721ZM10Medicare PIN
TX150791502Medicaid
TX323721ZG6FMedicare PIN