Provider Demographics
NPI:1063498475
Name:SHARMAN, KENT DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:DOUGLAS
Last Name:SHARMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4575
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4575
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCB3544OtherRR MEDICARE GROUP NUMBER
OR271593Medicaid
OR080186022OtherRR MEDICARE PTAN NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR930635514OtherGROUP TAX ID NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR080186022OtherRR MEDICARE PTAN NUMBER