Individual
MR. FREDRICK WILLIAM SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
21107 DONAHOO RD, TONGANOXIE, KS 66086-4153
(913) 742-4084
(913) 742-4086
Mailing address
PO BOX 996, TONGANOXIE, KS 66086-0996
(913) 742-4084
(913) 742-4086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0520840
KS
207Q00000X
Family Medicine Physician
R4C55
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09549174
BCBS
—
05
—
100230280C
—
KS
Enumeration date
05/18/2006
Last updated
09/24/2013
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