Basic Information
| Provider Information | |||||||||
| NPI: | 1710472345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUSTIN J. SHARP, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2709 E SLATEN PARK CIR | ||||||||
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| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571034645 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2175 ROSALINE AVE | ||||||||
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| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960012549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302256000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2018 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | SHARP | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4026503273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 156626 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.