Individual
BENNY LEE SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W ROSS BLVD, DODGE CITY, KS 67801-7221
(620) 371-7300
(620) 371-7304
Mailing address
200 W ROSS BLVD, DODGE CITY, KS 67801-7221
(620) 371-7300
(620) 371-7304
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
04-28386
KS
207Q00000X
Family Medicine Physician
04-28386
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100354710C
—
KS
05
—
100354710H
—
KS
05
—
100354710I
—
KS
01
—
102645
BC/BS
KS
Enumeration date
06/28/2006
Last updated
01/11/2022
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