=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871647008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINCLAIR SURGICAL PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 06/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 WEBB DRIVE SUITE B
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33837-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-421-4407
-----------------------------------------------------
Fax | 863-422-2888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2507
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33836-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-421-4407
-----------------------------------------------------
Fax | 863-422-2888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KARLENE E SINCLAIR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 863-421-4407
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME88406
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------