Provider Demographics
NPI:1720316573
Name:SHORT, RICHARD LESTER III (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LESTER
Last Name:SHORT
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2501 W BAY ISLE DR. SE
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705
Mailing Address - Country:US
Mailing Address - Phone:727-235-1149
Mailing Address - Fax:727-898-3427
Practice Address - Street 1:2501 W BAY ISLE DR. SE
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705
Practice Address - Country:US
Practice Address - Phone:727-235-1149
Practice Address - Fax:727-898-3427
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology