Healthcare Provider Details

I. General information

NPI: 1588687776
Provider Name (Legal Business Name): GLORI S SHORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 ST. VINCENT'S DRIVE SUITE 500
BIRMINGHAM AL
35205
US

IV. Provider business mailing address

806 ST. VINCENT'S DRIVE SUITE 500
BIRMINGHAM AL
35205
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-1800
  • Fax: 205-930-1818
Mailing address:
  • Phone: 205-930-1800
  • Fax: 205-930-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00020844
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: