Healthcare Provider Details

I. General information

NPI: 1073932570
Provider Name (Legal Business Name): JAMES D SHORTT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 48TH STREET CT E
BRADENTON FL
34208-5508
US

IV. Provider business mailing address

528 48TH STREET CT E
BRADENTON FL
34208-5508
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME67392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES D SHORTT
Title or Position: CEO
Credential: MD
Phone: 941-782-4545