Healthcare Provider Details

I. General information

NPI: 1013987551
Provider Name (Legal Business Name): HOWARD NEWTON SHORT MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 JEFFERSON ST STE 110
WASHINGTON MO
63090-6449
US

IV. Provider business mailing address

1351 JEFFERSON ST STE 110
WASHINGTON MO
63090-6449
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-1650
  • Fax: 636-239-9005
Mailing address:
  • Phone: 636-239-1650
  • Fax: 636-239-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR9366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: