Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 806 | WV |
NPI | 1134120173 |
---|---|
Provider Name | Dr. John C Sharp |
First Address | Marlinton, WV 24954-0320 |
Second Address | Marlinton, WV 24954-0320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0049786000 | (05) | WV |
0049786001 | (05) | WV |
E05947 | (02) | WV |