Provider Demographics
NPI:1891789301
Name:SHARRER, EDWARD A (DPM)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:SHARRER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S JOHN REDDITT DR.
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-632-5252
Mailing Address - Fax:936-632-5284
Practice Address - Street 1:200 S JOHN REDDITT DR.
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-632-5252
Practice Address - Fax:936-632-5284
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY125213E00000X
TX1791213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312912OtherBLUE CROSS
TX193055401Medicaid
WY120114000Medicaid
TXU69113Medicare UPIN
WY312912OtherBLUE CROSS
OHSH0837287Medicare PIN
OHSH0837289Medicare PIN
10217Medicare ID - Type Unspecified
OHSH4205791Medicare PIN
OHSH0837288Medicare PIN