Provider Demographics
NPI:1700870417
Name:SHORT, BRUCE H (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10601 QUIVIRA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2310
Mailing Address - Country:US
Mailing Address - Phone:913-541-3340
Mailing Address - Fax:913-492-7857
Practice Address - Street 1:10601 QUIVIRA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2310
Practice Address - Country:US
Practice Address - Phone:913-541-3340
Practice Address - Fax:913-492-7857
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-17923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100122410CMedicaid
KS04-17923OtherMEDICAL LICENSE
MO1700870417Medicaid
KS100122410CMedicaid
MO1700870417Medicaid