Provider Demographics
NPI:1689882045
Name:SHARPE, TIM (LAC)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:SHARPE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 GLENVISTA PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2020
Mailing Address - Country:US
Mailing Address - Phone:314-249-2697
Mailing Address - Fax:888-423-0987
Practice Address - Street 1:2712 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-3008
Practice Address - Country:US
Practice Address - Phone:314-315-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111171100000X
MO2008025556171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist