Healthcare Provider Details

I. General information

NPI: 1871586941
Provider Name (Legal Business Name): GARY C SHARP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 JASON RD
GREENFIELD IN
46140-1039
US

IV. Provider business mailing address

1471 JASON RD
GREENFIELD IN
46140-1039
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-4233
  • Fax: 317-462-7280
Mailing address:
  • Phone: 317-462-4233
  • Fax: 317-462-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01025164
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: