Provider Demographics
NPI:1083005904
Name:SHARRAH, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SHARRAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 659506
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:580-339-8001
Mailing Address - Fax:
Practice Address - Street 1:1710 W 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5160
Practice Address - Country:US
Practice Address - Phone:580-339-8001
Practice Address - Fax:580-339-8031
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILS60017286248390200000X
OK37661207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program