Provider Demographics
NPI:1871586941
Name:SHARP, GARY C (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:C
Last Name:SHARP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 JASON RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1039
Mailing Address - Country:US
Mailing Address - Phone:317-462-4233
Mailing Address - Fax:317-462-7280
Practice Address - Street 1:1471 JASON RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1039
Practice Address - Country:US
Practice Address - Phone:317-462-4233
Practice Address - Fax:317-462-7280
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100127570AMedicaid
IN100127570AMedicaid
INC24830Medicare UPIN