MEDICARE: BRIAN D SHORT DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1144790171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN D SHORT DPM

Provider Business Mailing Address
First Line	:	6200 PLEASANT AVE STE 3
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-4671
Country	:	US
Telephone Number	:	513-829-9333
Fax Number	:	513-858-7827

Provider Business Practice Location Address
First Line	:	2055 HOSPITAL DR STE 365
Second Line	:
City	:	BATAVIA
State	:	OH
Zip	:	45103-1953
Country	:	US
Telephone Number	:	513-732-2660
Fax Number	:	513-732-2525

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN D SHORT
Credential	:	DPM
Telephone Number	:	513-732-2660

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	12/03/2018

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