MEDICARE: MR. GARTH ROBERT ALAN SINCLAIR IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1215232608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARTH ROBERT ALAN SINCLAIR IDC

Provider Business Mailing Address
First Line	:	350 CRAG RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-7013
Country	:	US
Telephone Number	:	850-235-5215
Fax Number	:	850-235-5993

Provider Business Practice Location Address
First Line	:	350 CRAG RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-7013
Country	:	US
Telephone Number	:	850-235-5215
Fax Number	:	850-235-5993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	01/18/2011

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