Healthcare Provider Details

I. General information

NPI: 1114469731
Provider Name (Legal Business Name): JOHN SHARP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 S BOND AVE
PORTLAND OR
97239-4503
US

IV. Provider business mailing address

3485 S BOND AVE
PORTLAND OR
97239-4503
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-5058
  • Fax: 503-494-3465
Mailing address:
  • Phone: 503-494-5058
  • Fax: 503-346-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD228980
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA165902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: