Healthcare Provider Details

I. General information

NPI: 1730530924
Provider Name (Legal Business Name): SHARON OVERALL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 OAK HILL BLVD
TYLER TX
75703-0586
US

IV. Provider business mailing address

6603 OAK HILL BLVD
TYLER TX
75703-0586
US

V. Phone/Fax

Practice location:
  • Phone: 903-939-3668
  • Fax:
Mailing address:
  • Phone: 903-939-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002643
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: