Provider Demographics
NPI:1497791404
Name:SHARECK, EVERETT PATRICK JR
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:PATRICK
Last Name:SHARECK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:EVERETT
Other - Middle Name:PATRICK
Other - Last Name:SHARECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8117
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080
Mailing Address - Country:US
Mailing Address - Phone:530-529-1306
Mailing Address - Fax:530-529-4951
Practice Address - Street 1:1133 W SYCAMORE STREET
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988
Practice Address - Country:US
Practice Address - Phone:530-934-1800
Practice Address - Fax:530-934-1865
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40509207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G405090Medicaid
CA00G405092Medicare PIN
A48248Medicare UPIN