Provider Demographics
NPI:1770587172
Name:SHORTER, RICHARD A (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SHORTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:200 POCAHONTAS TRAIL
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0457
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:904 HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3011
Practice Address - Country:US
Practice Address - Phone:304-461-7100
Practice Address - Fax:304-461-7112
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2025-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV1105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
541839718OtherC&O
WV541839718107OtherBS MOUNTAIN STATE
262907OtherCARELINK
4324131OtherAETNA
VA010109892Medicaid
WV3810001390Medicaid
5181179OtherCCN
1038179OtherWV WORKERS COMPENSATION
WVP00173397OtherRAILROAD MEDICARE
1038179OtherWV WORKERS COMPENSATION
262907OtherCARELINK