Provider Demographics
NPI:1477889947
Name:JERRY W. SINCLAIR, M.D., PA
Entity Type:Organization
Organization Name:JERRY W. SINCLAIR, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-695-4133
Mailing Address - Street 1:1680 ANTILLEY RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5267
Mailing Address - Country:US
Mailing Address - Phone:325-691-1122
Mailing Address - Fax:
Practice Address - Street 1:1680 ANTILLEY RD
Practice Address - Street 2:SUITE 320
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5267
Practice Address - Country:US
Practice Address - Phone:325-691-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty