Provider Demographics
NPI:1689024382
Name:SHORT, CHRISTOPHER HAZEN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:HAZEN
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4101 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7588
Mailing Address - Country:US
Mailing Address - Phone:785-587-4101
Mailing Address - Fax:785-587-9090
Practice Address - Street 1:4101 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7588
Practice Address - Country:US
Practice Address - Phone:785-587-4101
Practice Address - Fax:785-587-9090
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018039700207Q00000X
KS04-42282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine