Individual
CECIL C. SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 853-0201
(540) 853-0931
Mailing address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 853-0201
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001794
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00376022
RAILROAD MEDICARE
VA
Enumeration date
11/20/2006
Last updated
02/29/2012
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