Provider Demographics
NPI:1609454719
Name:SHARAR, REBECCA ANNE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:SHARAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N BROADWAY
Mailing Address - Street 2:PO BOX 590
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068
Mailing Address - Country:US
Mailing Address - Phone:406-446-2345
Mailing Address - Fax:406-446-0095
Practice Address - Street 1:2525 N BROADWAY
Practice Address - Street 2:PO BOX 590
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068
Practice Address - Country:US
Practice Address - Phone:406-446-2345
Practice Address - Fax:406-446-0095
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-142490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine