Provider Demographics
NPI:1750301529
Name:SHARP, BRETT WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:WALLACE
Last Name:SHARP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 E 100 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4974
Mailing Address - Country:US
Mailing Address - Phone:757-995-5118
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:1277 E 100 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4974
Practice Address - Country:US
Practice Address - Phone:757-995-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT182472-12052084P0804X
VA0101-2401512084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010297222Medicaid
VA010297222Medicaid
010806L19Medicare PIN
VA010806L19Medicare PIN
VAF54270Medicare UPIN