MEDICARE: DR. LARRY E 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	207Q00000X	Family Medicine Physician	G5600	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8X9801	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588642722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY E SHARP M.D.

Provider Business Mailing Address
First Line	:	5410 MARYLAND WAY
Second Line	:	SUITE 300
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5064
Country	:	US
Telephone Number	:	615-377-5652
Fax Number	:	949-567-9827

Provider Business Practice Location Address
First Line	:	1600 11TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4300
Country	:	US
Telephone Number	:	940-764-3983
Fax Number	:	940-764-3978

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	12/17/2008

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