Provider Demographics
NPI:1770627481
Name:SHARP, DANIEL H (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
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:PO BOX 951
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-0951
Mailing Address - Country:US
Mailing Address - Phone:970-522-1833
Mailing Address - Fax:970-522-3677
Practice Address - Street 1:220 S 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4259
Practice Address - Country:US
Practice Address - Phone:970-522-1833
Practice Address - Fax:970-522-3677
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29002207W00000X
CODR0029002174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01290022Medicaid
CO01290022Medicaid
COCK10086Medicare PIN
COE97558Medicare UPIN