Individual
TRACEE CHAVAWN SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9618 JEFFERSON HWY STE D149, BATON ROUGE, LA 70809-9636
(478) 276-0513
Mailing address
9618 JEFFERSON HWY STE D149, BATON ROUGE, LA 70809-9636
(478) 276-0513
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD.206571
LA
208D00000X
General Practice Physician
E-6871
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2347799
—
LA
01
—
324582YUB6
MEDICARE PTAN
LA
Enumeration date
07/02/2009
Last updated
08/19/2025
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