| NPI | 1306846795 |
|---|---|
| Former Name | MARY ELIZABETH SHORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 10534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02005514A) |
| 207Q00000X Family Medicine (Licence: DC DO034780) | |
| 207Q00000X Family Medicine (Licence: NC 2018-02504) | |
| 207Q00000X Family Medicine (Licence: SC 81617) | |
| 207Q00000X Family Medicine (Licence: VA 0102205452) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2020-02-12 |