Provider Demographics
| NPI: | 1497065361 |
|---|---|
| Name: | SHARP REES-STEALY MEDICAL GROUP INC |
| Entity Type: | Organization |
| Organization Name: | SHARP REES-STEALY MEDICAL GROUP INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | ALAN |
| Authorized Official - Middle Name: | J |
| Authorized Official - Last Name: | BIER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 858-262-6344 |
| Mailing Address - Street 1: | PO BOX 939087 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAN DIEGO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 92193-9087 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 858-262-6344 |
| Mailing Address - Fax: | 858-636-2032 |
| Practice Address - Street 1: | 5525 GROSSMONT CENTER DR |
| Practice Address - Street 2: | |
| Practice Address - City: | LA MESA |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 91942 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 619-446-1646 |
| Practice Address - Fax: | 858-636-2032 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | SHARP REES-STEALY MEDICAL GROUP, INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2010-10-13 |
| Last Update Date: | 2018-07-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | GRE001804 | Medicaid | |
| CA | GR0021729 | Medicaid | |
| CA | GR0021729 | Medicaid | |
| CA | 6493130012 | Medicare NSC |
