Provider Demographics
NPI:1841300340
Name:SHORT, WILLIAM L (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2153
Mailing Address - Country:US
Mailing Address - Phone:785-263-4131
Mailing Address - Fax:785-263-1634
Practice Address - Street 1:1111 N BRADY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-1804
Practice Address - Country:US
Practice Address - Phone:785-263-4131
Practice Address - Fax:785-263-1634
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100367770AMedicaid
KSG93331Medicare UPIN