Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 16709 | ND |
NPI | 1043676414 |
---|---|
Provider Name | Jason Sharp |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Fargo, ND 58103-4940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2016 |
Last Update Date | 05/08/2021 |