Individual
MARK S SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
126 MISSOURI AVE, MCXP-CCS-CR, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0417
(573) 596-0524
Mailing address
126 MISSOURI AVE, MCXP-CCS-CR, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0417
(573) 596-0524
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2011012296
MO
Other
Enumeration date
07/25/2006
Last updated
05/06/2021
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