Provider Demographics
NPI:1639175847
Name:BAKOS, SHARON GRIMES (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:GRIMES
Last Name:BAKOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:G
Other - Last Name:BAKOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:519 FARINE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3632
Mailing Address - Country:US
Mailing Address - Phone:972-255-8549
Mailing Address - Fax:972-255-8549
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:LABOR AND DELIVERY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:866-240-8099
Practice Address - Fax:972-255-8549
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3127174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13097Medicare UPIN