Provider Demographics
NPI:1891757613
Name:SINCLAIR, GARY I (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:I
Last Name:SINCLAIR
Suffix:
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 1:219 SUNSET AVE STE 116A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4531
Mailing Address - Country:US
Mailing Address - Phone:972-807-7370
Mailing Address - Fax:972-807-7381
Practice Address - Street 1:219 SUNSET AVE STE 116A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4531
Practice Address - Country:US
Practice Address - Phone:972-807-7370
Practice Address - Fax:972-807-7381
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0936207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038836501Medicaid
ND17773Medicaid
TX038836501Medicaid
TX8147J9Medicare ID - Type Unspecified
NDN718638Medicare PIN
NDN718637Medicare PIN