Healthcare Provider Details

I. General information

NPI: 1780813311
Provider Name (Legal Business Name): TRACEE CHAVAWN SHORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9618 JEFFERSON HWY STE D149
BATON ROUGE LA
70809-9636
US

IV. Provider business mailing address

9618 JEFFERSON HWY STE D149
BATON ROUGE LA
70809-9636
US

V. Phone/Fax

Practice location:
  • Phone: 478-276-0513
  • Fax:
Mailing address:
  • Phone: 478-276-0513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.206571
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE-6871
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: