Provider Demographics
NPI:1881677540
Name:DEHART, SHARON DENISON (PAC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DENISON
Last Name:DEHART
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 HIGH ST
Mailing Address - Street 2:STE 224
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3238
Mailing Address - Country:US
Mailing Address - Phone:541-500-2500
Mailing Address - Fax:
Practice Address - Street 1:1605 GEORGE JACKSON RD
Practice Address - Street 2:
Practice Address - City:MAUPIN
Practice Address - State:OR
Practice Address - Zip Code:97037-9208
Practice Address - Country:US
Practice Address - Phone:541-395-2911
Practice Address - Fax:541-395-2912
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00762363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500606326Medicaid
OR500606326Medicaid
ORR138258Medicare PIN