Provider Demographics
NPI:1336440023
Name:J. NEAL SHARPE, M.D. SURGICAL WOUND SPECIALIST, PLLC
Entity Type:Organization
Organization Name:J. NEAL SHARPE, M.D. SURGICAL WOUND SPECIALIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-412-2995
Mailing Address - Street 1:10821 PLANTSIDE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6132
Mailing Address - Country:US
Mailing Address - Phone:502-412-2995
Mailing Address - Fax:502-412-8025
Practice Address - Street 1:10821 PLANTSIDE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6132
Practice Address - Country:US
Practice Address - Phone:502-412-2995
Practice Address - Fax:502-412-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24075208600000X
KY3002826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142370Medicaid
KY7100153120Medicaid
IN201015970AMedicaid
KYP100033758Medicare PIN