Healthcare Provider Details

I. General information

NPI: 1710160387
Provider Name (Legal Business Name): GARY C. SHARP, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 JASON RD
GREENFIELD IN
46140-1158
US

IV. Provider business mailing address

1471 JASON RD
GREENFIELD IN
46140-1097
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 Code208D00000X
TaxonomyGeneral Practice Physician
License Number01025164
License Number StateIN

VIII. Authorized Official

Name: GARY C SHARP
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 317-462-4233