Provider Demographics
NPI:1811054695
Name:SHARP, GARY H (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:H
Last Name:SHARP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 S HIGHWAY 40
Mailing Address - Street 2:SUITE E
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032
Mailing Address - Country:US
Mailing Address - Phone:801-387-5300
Mailing Address - Fax:
Practice Address - Street 1:1473 S HIGHWAY 40
Practice Address - Street 2:SUITE E
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3522
Practice Address - Country:US
Practice Address - Phone:435-657-4400
Practice Address - Fax:435-657-4460
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5602490-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854058520Medicaid
UT942854058520Medicaid
000063518Medicare PIN
UT000060132Medicare PIN
E41522Medicare UPIN
UT000060888Medicare PIN