Provider Demographics
NPI:1073592523
Name:SHARP, JAN C (M D)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:SHARP
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 STACY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-7798
Mailing Address - Country:US
Mailing Address - Phone:501-362-2414
Mailing Address - Fax:501-362-7068
Practice Address - Street 1:401 W SEARCY ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3842
Practice Address - Country:US
Practice Address - Phone:501-362-2414
Practice Address - Fax:501-362-7068
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123682001Medicaid
ARF60267Medicare UPIN
AR123682001Medicaid