Provider Demographics
NPI:1033304126
Name:LAURENCE M SHARP DO PC
Entity Type:Organization
Organization Name:LAURENCE M SHARP DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-459-1611
Mailing Address - Street 1:1813 W HARVARD AVE
Mailing Address - Street 2:SUITE 426
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2752
Mailing Address - Country:US
Mailing Address - Phone:541-459-1611
Mailing Address - Fax:541-459-5741
Practice Address - Street 1:1813 W HARVARD AVE
Practice Address - Street 2:SUITE 426
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2752
Practice Address - Country:US
Practice Address - Phone:541-459-1611
Practice Address - Fax:541-459-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO15192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150144Medicaid
OR150144Medicaid
R110024Medicare PIN