MEDICARE: DR. ELAINE C SHARP M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	036107352	IL
2	207V00000X	Obstetrics & Gynecology Physician	55013	FL
3	207VG0400X	Gynecology Physician	ME55013	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356342786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE C SHARP M.D.

Provider Business Mailing Address
First Line	:	1395 EL RITO DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-6707
Country	:	US
Telephone Number	:	850-733-9343
Fax Number	:	850-733-9446

Provider Business Practice Location Address
First Line	:	1395 EL RITO DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-6707
Country	:	US
Telephone Number	:	850-733-9343
Fax Number	:	850-733-9446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/05/2020

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