Provider Demographics
NPI:1508817453
Name:SHARP, RICHARD KEITH (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEITH
Last Name:SHARP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:3300 N RUNNING CREEK WAY
Practice Address - Street 2:BLDG B STE 100
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5565
Practice Address - Country:US
Practice Address - Phone:801-766-4214
Practice Address - Fax:801-407-3052
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT318535-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1326107764Medicaid
UTG54723Medicare UPIN