Individual
KEVIN A SHORT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(469) 757-1000
Mailing address
627 TURTLE CREEK DR, TYLER, TX 75701-1832
(903) 593-2539
(903) 593-0559
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J0252
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133194402
—
TX
Enumeration date
03/30/2006
Last updated
01/17/2020
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