Healthcare Provider Details

I. General information

NPI: 1033304126
Provider Name (Legal Business Name): LAURENCE M SHARP DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W HARVARD AVE SUITE 426
ROSEBURG OR
97471-2752
US

IV. Provider business mailing address

1813 W HARVARD AVE SUITE 426
ROSEBURG OR
97471-2752
US

V. Phone/Fax

Practice location:
  • Phone: 541-459-1611
  • Fax: 541-459-5741
Mailing address:
  • Phone: 541-459-1611
  • Fax: 541-459-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO15192
License Number StateOR

VIII. Authorized Official

Name: DR. LAURENCE M SHARP
Title or Position: PRESIDENT
Credential: DO
Phone: 541-459-1611