Healthcare Provider Details

I. General information

NPI: 1861670853
Provider Name (Legal Business Name): BRUCE V SHARP BC-HIS, ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 2100 S STE 120
SALT LAKE CITY UT
84115-1855
US

IV. Provider business mailing address

140 W 2100 S STE 120
SALT LAKE CITY UT
84115-1855
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-3277
  • Fax:
Mailing address:
  • Phone: 801-484-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1052324601
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: