MEDICARE: DR. GREGORY EVAN 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	40965	CO
2	207Q00000X	Family Medicine Physician	95170	GA
3	207Q00000X	Family Medicine Physician	68244	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	665966	OTHER	CO	ANTHEM BC/BS PROVIDER #

General Provider Information

NPI Number	:	1679564827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY EVAN SHARP M.D.

Provider Business Mailing Address
First Line	:	335 MANITOU AVE
Second Line	:
City	:	MANITOU SPRINGS
State	:	CO
Zip	:	80829-2537
Country	:	US
Telephone Number	:	719-686-8844
Fax Number	:	719-686-7449

Provider Business Practice Location Address
First Line	:	335 MANITOU AVE
Second Line	:
City	:	MANITOU SPRINGS
State	:	CO
Zip	:	80829-2537
Country	:	US
Telephone Number	:	719-686-8844
Fax Number	:

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	06/05/2025

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