Organization
BERT E. SHARP, D.P.M., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERT EAGLE SHARP DPM (OWNER)
(903) 757-2300
Entity
Organization
Contact information
Practice address
613 N 4TH ST, LONGVIEW, TX 75601-6616
(903) 757-2300
(903) 758-0279
Mailing address
613 N 4TH ST, LONGVIEW, TX 75601-6616
(903) 757-2300
(903) 758-0279
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1032
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A35L
MEDICARE
TX
05
—
092750102
—
TX
01
—
T15859
UPIN
TX
Enumeration date
02/14/2008
Last updated
01/13/2009
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