Individual
JOHN P SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1325 SPRING ST, GREENWOOD, SC 29646-3860
(864) 725-4780
(864) 725-4778
Mailing address
1325 SPRING ST, GREENWOOD, SC 29646-3860
(864) 725-4780
(864) 725-4778
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1651
SC
207P00000X
Emergency Medicine Physician
1982
WV
207Q00000X
Family Medicine Physician
2001
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016510
—
SC
05
—
1811051000
—
WV
05
—
2774136
—
OH
Enumeration date
06/02/2006
Last updated
08/11/2021
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