Individual
DR. JACK KEVIN SHARP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2131 S 17TH ST, WILMINGTON, NC 28401-7407
(910) 662-8888
(910) 662-8909
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 662-8888
(910) 662-8909
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
2012-01911
NC
2080P0214X
Pediatric Pulmonology Physician
216985
NY
2080P0214X
Pediatric Pulmonology Physician
216985-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00021037301
UNIVERA
—
01
—
000525957001
BC/BS
—
05
—
001819708001
—
PA
05
—
02062031
—
NY
01
—
040426001868
FIDELIS
—
01
—
4410946
IHA
—
Enumeration date
04/17/2006
Last updated
07/12/2023
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