Provider Demographics
NPI:1497163117
Name:SHARPE, DARSEAN (IDC)
Entity Type:Individual
Prefix:
First Name:DARSEAN
Middle Name:
Last Name:SHARPE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 EXPO BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230
Mailing Address - Country:US
Mailing Address - Phone:678-595-5032
Mailing Address - Fax:
Practice Address - Street 1:USS CHINOOK
Practice Address - Street 2:PC9
Practice Address - City:MAHATMA
Practice Address - State:BAHRAIN
Practice Address - Zip Code:APO
Practice Address - Country:BH
Practice Address - Phone:678-595-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman