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General NPI Number Information
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NPI Number | 1558880757
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Entity Type | Organization
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Legal Business Name | KELLY A. SHARRAR, M.D.
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4981 INDIAN PEAK RD
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City | MARIPOSA
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State | CA
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Zip | 95338-9373
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Country | US
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Telephone | 209-682-5228
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Fax | 209-682-5227
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Provider Business Mailing Address
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Address Line | PO BOX 2301
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City | MARIPOSA
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State | CA
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Zip | 95338-2301
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Country | US
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Telephone | 209-682-5228
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Fax | 209-682-5227
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. KELLY A SHARRAR
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Credential | MD
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Telephone | 209-682-5228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A93376
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License Number State | CA
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