Provider Demographics
NPI:1134124977
Name:SHARPE, JEFFREY NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEAL
Last Name:SHARPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:NEAL
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 420
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-899-6405
Practice Address - Fax:502-899-6407
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24075208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201015970Medicaid
KY64240757Medicaid
KY130993OtherSIHO-NNS
KYP01294746OtherMEDICARE RR-NNS
KY50069519OtherPASSPORT-NNS
KY000000048706OtherANTHEM BLUE CROSS
KY000000853600OtherANTHEM-NNS
KY130993OtherSIHO-NNS
KYP01294746OtherMEDICARE RR-NNS
KYD92455Medicare UPIN
IN201015970Medicaid