Healthcare Provider Details

I. General information

NPI: 1679512933
Provider Name (Legal Business Name): TIMOTHY J SHORT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N ALVERNON WAY #251-C
TUCSON AZ
85711-1843
US

IV. Provider business mailing address

2202 N FORBES BLVD
TUCSON AZ
85745-1412
US

V. Phone/Fax

Practice location:
  • Phone: 520-319-3283
  • Fax: 520-319-3982
Mailing address:
  • Phone: 520-319-3283
  • Fax: 520-319-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number647
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: