Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 33744 | AL |
NPI | 1104913235 |
---|---|
Provider Name | Deron Sharpe |
First Address | Dothan, AL 36303-1980 |
Second Address | Dothan, AL 36303-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 15/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003152661A | (05) | GA |
013602700 | (05) | FL |
165797 | (05) | AL |
511-54132 | BC/BS (01) | AL |
H96191 | (02) |