Provider Demographics
NPI:1386627362
Name:SHARP, PHILIP MARION (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:MARION
Last Name:SHARP
Suffix:
Gender:M
Credentials:MD
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 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-773-8012
Mailing Address - Fax:307-633-7676
Practice Address - Street 1:214 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3748
Practice Address - Country:US
Practice Address - Phone:307-633-6080
Practice Address - Fax:307-432-3106
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2371A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY430PS98OtherSUBSTANCE CONTROL
WY102341100Medicaid
WY2371AOtherSTATE LICENSE
WY2371AOtherSTATE LICENSE
WY430PS98OtherSUBSTANCE CONTROL