Provider Demographics
NPI:1316900376
Name:SHARP, BERT EAGLE (DPM)
Entity type:Individual
Prefix:
First Name:BERT
Middle Name:EAGLE
Last Name:SHARP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6616
Mailing Address - Country:US
Mailing Address - Phone:903-757-2300
Mailing Address - Fax:903-758-0279
Practice Address - Street 1:613 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6616
Practice Address - Country:US
Practice Address - Phone:903-757-2300
Practice Address - Fax:903-758-0279
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032213E00000X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A35LOtherBLUE CROSS BLUE SHIELD
TX4651102OtherAETNA
TX092750101Medicaid
TX092750102Medicaid
TX752573608OtherTAX ID
TX0525290001Medicare NSC
TX00A35LMedicare ID - Type UnspecifiedLONGVIEW LOCATION
TX092750101Medicaid
TX092750102Medicaid