# KERRY L SHORT, M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962686261
- **Authorized official:** DR. KERRY LYNN SHORY M.D. (OWNER)
- **Authorized official phone:** (502) 897-7416

## Contact information

- **Practice address:** 4001 KRESGE WAY STE 315, LOUISVILLE, KY 40207-4640
- **Practice address phone:** (502) 897-7416
- **Practice address fax:** (502) 895-6638
- **Mailing address:** 4001 KRESGE WAY STE 315, LOUISVILLE, KY 40207-4640
- **Mailing address phone:** (502) 897-7416
- **Mailing address fax:** (502) 895-6638

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 20965 | KY | Yes |

## Other

- **Enumeration date:** 12/21/2007
- **Last updated:** 12/21/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 64209653 | — | KY |