Individual
RANDALL LEE SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
556 NORTH MAIN STREET, CHAPMANVILLE, WV 25508
(304) 549-1139
Mailing address
556 MAIN STREET, CHAPMANVILLE, WV 25508
(304) 549-1139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
796
WV
Other
Enumeration date
12/30/2008
Last updated
12/30/2008
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