Individual
BRIAN J SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4620 MIDDLEBORO LANE, RICHMOND, IN 47374
(765) 966-1391
Mailing address
4620 MIDDLEBORO LANE, RICHMOND, IN 47374
(765) 966-1391
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001054A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000731844
ANTHEM BCBS
IN
05
—
200361020
—
IN
Enumeration date
02/23/2006
Last updated
08/18/2016
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