NPI 1194748863

Mark S Short, PAC

Practitioner Physician Assistant Fort Leonard Wood, MO

Practice location

Address: 126 Missouri Ave McXp-Ccs-Cr, Fort Leonard Wood, MO 65473-8952
Phone: (573) 596-0417
Fax: (573) 596-0524

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 2011012296 (MO)

Other Physician Assistant providers in Missouri →

Registry record

NPI: 1194748863
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 Jul 2006
Record last updated: 6 May 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.