Provider Demographics
NPI:1043300783
Name:HARGRAVES, SHARON D (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:HARGRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 S LAKESHORE DR STE 136
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7127
Mailing Address - Country:US
Mailing Address - Phone:480-414-3077
Mailing Address - Fax:480-393-7444
Practice Address - Street 1:4635 S LAKESHORE DR STE 136
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7127
Practice Address - Country:US
Practice Address - Phone:480-414-3077
Practice Address - Fax:480-393-7444
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD061055207L00000X
AZ32527207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1379937OtherAETNA
ME432213099Medicaid
MEH32975OtherHARVARD
MEPENDINGOtherANTHEM
AZZ125944Medicare PIN
H32975Medicare UPIN
ME1379937OtherAETNA
AZP00694179Medicare PIN