Healthcare Provider Details

I. General information

NPI: 1073968210
Provider Name (Legal Business Name): SHARP SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30715 GINGER TRACE DR
SPRING TX
77386-4021
US

IV. Provider business mailing address

PO BOX 2126
SPRING TX
77383-2126
US

V. Phone/Fax

Practice location:
  • Phone: 281-210-9934
  • Fax:
Mailing address:
  • Phone: 281-210-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberSA00652
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. ELEAZAR FLORES
Title or Position: OWNER
Credential: LSA
Phone: 281-210-9934