Provider Demographics
NPI:1780677146
Name:SHARP, LAURENCE M (DO)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:M
Last Name:SHARP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0462
Mailing Address - Country:US
Mailing Address - Phone:541-459-1611
Mailing Address - Fax:541-459-5741
Practice Address - Street 1:1813 W HARVARD AVE
Practice Address - Street 2:SUITE 426
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2752
Practice Address - Country:US
Practice Address - Phone:541-459-1611
Practice Address - Fax:541-459-5741
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO15192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150144Medicaid
ORR150569Medicare PIN
ORC91344Medicare UPIN