Provider Demographics
NPI:1164479986
Name:SHARPE, KIPLING P (MD)
Entity Type:Individual
Prefix:DR
First Name:KIPLING
Middle Name:P
Last Name:SHARPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIPLING
Other - Middle Name:PITAMAKAN
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 80217
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-0217
Mailing Address - Country:US
Mailing Address - Phone:602-385-2115
Mailing Address - Fax:480-418-3323
Practice Address - Street 1:2940 E BANNER GATEWAY DR
Practice Address - Street 2:STE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2168
Practice Address - Country:US
Practice Address - Phone:480-964-2908
Practice Address - Fax:480-833-2136
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22196207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ161464Medicaid
AZ3Z3978OtherHEALTHNET
AZZ137032Medicare PIN
AZ3Z3978OtherHEALTHNET