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NPI Code Detail

MEDICARE: MICHAEL DANIEL SHORTT PA-C

MEDICARE: MICHAEL DANIEL SHORTT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA06116TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972640266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DANIEL SHORTT PA-C
Provider Business Mailing Address
First Line : 18152 PRESTON RD STE I-2
Second Line :
City : DALLAS
State : TX
Zip : 75252-5427
Country : US
Telephone Number : 469-200-2832
Fax Number : 469-269-1074
Provider Business Practice Location Address
First Line : 18152 PRESTON RD STE I-2
Second Line :
City : DALLAS
State : TX
Zip : 75252-5427
Country : US
Telephone Number : 469-200-2832
Fax Number : 469-269-1074
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 09/14/2022

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Directions to “ MICHAEL DANIEL SHORTT PA-C” Practice Location

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