Provider Demographics
| NPI: | 1285616177 |
|---|---|
| Name: | SHARP REES-STEALY MEDICAL GROUP, INC |
| Entity type: | Organization |
| Organization Name: | SHARP REES-STEALY MEDICAL GROUP, INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | ALAN |
| Authorized Official - Middle Name: | J |
| Authorized Official - Last Name: | BIER |
| Authorized Official - Suffix: | III |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 858-262-6666 |
| Mailing Address - Street 1: | 5651 COPLEY DR STE A |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAN DIEGO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 92111-7903 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 858-262-6666 |
| Mailing Address - Fax: | 619-696-1579 |
| Practice Address - Street 1: | 5651 COPLEY DR STE A |
| Practice Address - Street 2: | |
| Practice Address - City: | SAN DIEGO |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 92111-7903 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 858-262-6666 |
| Practice Address - Fax: | 858-262-6777 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-11-16 |
| Last Update Date: | 2022-09-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | GR0021720 | Medicaid | |
| CA | GR0021724 | Medicaid | |
| CA | GR0021722 | Medicaid | |
| CA | GR0021721 | Medicaid | |
| CA | GR0021725 | Medicaid | |
| CA | GR0021726 | Medicaid | |
| CA | GR0021729 | Medicaid | |
| CA | GR0021728 | Medicaid | |
| CA | GR0021727 | Medicaid | |
| CA | GR0021723 | Medicaid | |
| CA | GR0021728 | Medicaid |
