Individual
BERT EAGLE SHARP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
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
1032
TX
213ER0200X
Radiology Podiatrist
1032
TX
213ES0000X
Sports Medicine Podiatrist
1032
TX
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1032
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A35L
BLUE CROSS BLUE SHIELD
TX
05
—
092750101
—
TX
05
—
092750102
—
TX
01
—
4651102
AETNA
TX
01
—
752573608
TAX ID
TX
Enumeration date
04/10/2006
Last updated
09/16/2024
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