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General NPI Number Information
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NPI Number | 1710215041
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Entity Type | Organization
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Legal Business Name | DR. BRADLEY M. SHORT, D.O., P.A.
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 3905 BROOKEN HILL DR
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City | FORT SMITH
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State | AR
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Zip | 72908-9282
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Country | US
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Telephone | 479-646-3345
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Fax | 478-646-6049
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Provider Business Mailing Address
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Address Line | 3905 BROOKEN HILL DR
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City | FORT SMITH
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State | AR
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Zip | 72908-9282
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Country | US
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Telephone | 479-646-3345
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Fax | 478-646-6049
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Authorized Official
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Title or Position | PRESIDEN
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Name | DR. BRADLEY MARK SHORT
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Credential | D.O.
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Telephone | 479-646-3345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | C7559
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License Number State | AR
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