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General NPI Number Information
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NPI Number | 1497620256
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Entity Type | Organization
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Legal Business Name | SHORT MEDICAL GROUP
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 500 RUE DE LA VIE ST STE 310
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City | BATON ROUGE
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State | LA
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Zip | 70817-5128
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Country | US
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Telephone | 225-242-9019
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Fax |
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Provider Business Mailing Address
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Address Line | 9618 JEFFERSON HWY STE D149
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City | BATON ROUGE
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State | LA
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Zip | 70809-9636
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Country | US
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Telephone | 225-242-9019
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACEE SHORT
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Credential | MD
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Telephone | 225-242-9019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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