Provider Demographics
NPI:1134298417
Name:JENNIFER L SHARP-SAUNDERS MD PA
Entity Type:Organization
Organization Name:JENNIFER L SHARP-SAUNDERS MD PA
Other - Org Name:JENNIFER L RHODES MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHARP-SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-968-3720
Mailing Address - Street 1:715 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1623
Mailing Address - Country:US
Mailing Address - Phone:979-968-3720
Mailing Address - Fax:979-968-3774
Practice Address - Street 1:715 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1623
Practice Address - Country:US
Practice Address - Phone:979-968-3720
Practice Address - Fax:979-968-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162556801Medicaid
TX162556802Medicaid
TX162556801Medicaid
TX162556802Medicaid