Individual
ETHAN SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
228 DELMONT AVE, LOUISVILLE, KY 40206-1025
(502) 619-0636
Mailing address
228 DELMONT AVE, LOUISVILLE, KY 40206-1025
(502) 619-0636
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01091358A
IN
2084P0800X
Psychiatry Physician
Primary
54489
KY
2084P0800X
Psychiatry Physician
R4865
KY
208D00000X
General Practice Physician
54489
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2017
Last updated
08/22/2023
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