Healthcare Provider Details

I. General information

NPI: 1477576577
Provider Name (Legal Business Name): J CLEVELAND SHARP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 JOURNAL CENTER BLVD NE
ALBUQUERQUE NM
87109-5900
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-3233
  • Fax: 505-262-3191
Mailing address:
  • Phone: 505-262-3233
  • Fax: 505-262-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80297
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: