Healthcare Provider Details

I. General information

NPI: 1891757613
Provider Name (Legal Business Name): GARY I SINCLAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 SUNSET AVE STE 116A
DALLAS TX
75208-4531
US

IV. Provider business mailing address

219 SUNSET AVE STE 116A
DALLAS TX
75208-4531
US

V. Phone/Fax

Practice location:
  • Phone: 972-807-7370
  • Fax: 972-807-7381
Mailing address:
  • Phone: 972-807-7370
  • Fax: 972-807-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberL0936
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL0936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: