Provider Demographics
NPI:1215232608
Name:SINCLAIR, GARTH ROBERT ALAN (IDC)
Entity Type:Individual
Prefix:MR
First Name:GARTH
Middle Name:ROBERT ALAN
Last Name:SINCLAIR
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CRAG RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32407-7013
Mailing Address - Country:US
Mailing Address - Phone:850-235-5215
Mailing Address - Fax:850-235-5993
Practice Address - Street 1:350 CRAG RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-7013
Practice Address - Country:US
Practice Address - Phone:850-235-5215
Practice Address - Fax:850-235-5993
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman