Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 216985 | NY |
N | 2080P0214X | Pediatric Pulmonologist | 216985-1 | NY |
NPI | 1104880079 |
---|---|
Provider Name | Dr. Jack Kevin Sharp |
First Address | Amherst, NY 14226-3822 |
Second Address | Buffalo, NY 14222-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 08/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00021037301 | UNIVERA (01) | |
000525957001 | BC/BS (01) | |
001819708001 | (05) | PA |
02062031 | (05) | NY |
040426001868 | FIDELIS (01) | |
4410946 | IHA (01) | |
G14010 | (02) | |
G14010 | (02) | NY |