IndividualActive
Baron Short
NPI 1811220577 · Customized Equipment (DME) · O Fallon, IL
Provider details
- NPI number
- 1811220577
- Entity type
- Individual
- Primary specialty
- Customized Equipment (DME)Suppliers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 3949-4810 (IL)
Specialties & taxonomies
Suppliers
Practice location
729 W US Highway 50
Ste F
O Fallon, IL 62269-1972
Phone: (618) 447-3392
Approximate (ZIP-level) locationGet directions
Mailing address
729 W US Highway 50
O Fallon, IL 62269-1972
Registry dates
- Enumerated
- 2009-09-14
- Last updated
- 2009-09-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.