Provider Demographics
NPI:1053527523
Name:SHORT, JODY LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:LEE
Last Name:SHORT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:200 MEDICAL CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2688
Mailing Address - Country:US
Mailing Address - Phone:937-523-9480
Mailing Address - Fax:937-523-9490
Practice Address - Street 1:200 MEDICAL CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2688
Practice Address - Country:US
Practice Address - Phone:937-523-9480
Practice Address - Fax:937-523-9490
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2023-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHPENDING2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1053527523OtherNPI