Basic Information
| Provider Information | |||||||||
| NPI: | 1962707331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHORT | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 N 13TH ST | ||||||||
| Address2: | |||||||||
| City: | DUNCAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735334041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186052764 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2515 W ELK AVE | ||||||||
| Address2: | |||||||||
| City: | DUNCAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735331571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802526080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2011 | ||||||||
| LastUpdateDate: | 01/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA1981 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.