Provider Demographics
NPI:1508855198
Name:SHARP, CLINTON HARRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:HARRY
Last Name:SHARP
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1051 GAUSE BLVD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2951
Mailing Address - Country:US
Mailing Address - Phone:985-641-8191
Mailing Address - Fax:985-641-9812
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 380
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2951
Practice Address - Country:US
Practice Address - Phone:985-641-8191
Practice Address - Fax:985-641-9812
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA16693207Q00000X
MS11192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08205520Medicaid
LA1386405Medicaid
LA1386405Medicaid
MS08205520Medicaid