Provider Demographics
NPI:1811078827
Name:SHARY, JOHN H III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:SHARY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:SOUR LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:77659-2009
Mailing Address - Country:US
Mailing Address - Phone:409-287-4243
Mailing Address - Fax:409-287-3970
Practice Address - Street 1:8542 WILKINS RANCH RD
Practice Address - Street 2:
Practice Address - City:SOUR LAKE
Practice Address - State:TX
Practice Address - Zip Code:77659
Practice Address - Country:US
Practice Address - Phone:409-287-4243
Practice Address - Fax:409-287-3970
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000QK340Medicaid
TXA61454Medicare UPIN
TX00QK34Medicare ID - Type Unspecified