1932117470 NPI number — DAVID G SHARP D.O.

Table of content: DAVID G SHARP D.O. (NPI 1932117470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932117470 NPI number — DAVID G SHARP D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARP
Provider First Name:
DAVID
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932117470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18011 OAK ST UNIT 18011A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68130-6057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-502-9454
Provider Business Mailing Address Fax Number:
402-505-8209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18011 OAK ST UNIT 18011A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68130-6057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-502-9454
Provider Business Practice Location Address Fax Number:
402-505-8209
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  144 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31565 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 30696 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: P00379255 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0402690 . This is a "UHC SHARE ADVANTAGE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025485600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00332774 . This is a "MEDICARE RAILROAD D4S" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0402527 . This is a "UHC SHARE ADVANTAGE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 12291 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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